Individual
TIFFANY BLANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC, NCC
Contact information
Practice address
1448 DIEDERICH BOULVEARD, RUSSELL, KY 41169
(606) 834-0020
(606) 834-0049
Mailing address
1448 DIEDERICH BLVD, RUSSELL, KY 41169-1719
(606) 834-0020
(606) 834-0049
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1163
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000558499
ANTHEM BCBS
—
01
—
2886911
UNITED HEALTHCARE
—
05
—
30610026
—
KY
Enumeration date
09/17/2006
Last updated
02/24/2017
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