Tiffany Samuelson, LMSW, CADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

13042 Issued in IA

Practice address

1021 Nebraska St
Sioux City, IA 51105-1436

Phone

(122) 522-4777

Fax

(712) 252-5920

NPI assigned

Mar 18, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Siouxland Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Sioux City, IA
  • NPI 1558355305
  Medicare reassignment NPD
• Siouxland Community Health Center

  • Federally Qualified Health Center (FQHC)
  • South Sioux City, NE
  • NPI 1912378480
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572393600000",
    "number": "1083075006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3320 W 4TH ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511033200",
            "telephone_number": "712-202-0777",
            "fax_number": "712-234-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 NEBRASKA ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511051436",
            "telephone_number": "122-522-4777",
            "fax_number": "712-252-5920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "TIFFANY",
        "credential": "LMSW, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-18",
        "last_updated": "2019-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "073276",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "13042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Marie Sachau
• Kelly Jean Sachau, LMHC
• Sacred Encounter Hospice NW Iowa, LLC
• Shawn Rene Salmen, NP-C
• Ivan King Salmons, D.D.S.
• William Oliver Samuelson, MD
• Castelia Y Sanchez
• Hilary Nicole Sanchez, OTD,OTR/L
• Raul Sanchez, PH.D
• Alisha Sandage, R.D., L.D., L.M.N.T

• Addiction (Substance Use Disorder) Counselor in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Addiction (Substance Use Disorder) Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.