Individual provider Active NPI

Tiffany Lin

  • Psychologist
  • Saint Louis, MO
National Provider Identifier
1104478536
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
11144 Tesson Ferry Rd Ste 101
Saint Louis, MO 63123-6965
Phone
(314) 729-1200
Fax
(314) 729-1201
NPI assigned
Jul 16, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X Primary

Addresses

Primary practice location

11144 Tesson Ferry Rd Ste 101
Saint Louis, MO 63123-6965

Mailing address

11144 Tesson Ferry Rd Ste 101
Saint Louis, MO 63123-6965
Phone (314) 729-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191016000776 MO Practitioner - Clinical Psychologist 4486985835 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shanon Harlow LLCGroup PAC ID 3375860588, 12 clinicians

Practice addresses (Care Compare)

11144 Tesson Ferry Rd
Suite 101
Saint Louis, MO 63123-6965
Phone (314) 729-1200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Shanon Harlow, LLC CurrentSince Sep 28, 2019 Accepting new patients

Locations

11144 Tesson Ferry Rd
Saint Louis, MO 63123
Phone (314) 729-1200

12801 Flushing Meadows Dr
Ste 120
Saint Louis, MO 63131
Phone (314) 729-1200

11144 Tesson Ferry Rd
Ste 101
Saint Louis, MO 63123
Phone (314) 472-2100

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1104478536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11144 TESSON FERRY RD STE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631236965",
            "telephone_number": "314-729-1200",
            "fax_number": "314-729-1201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11144 TESSON FERRY RD STE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631236965",
            "telephone_number": "314-729-1200",
            "fax_number": "314-729-1201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIN",
        "first_name": "TIFFANY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-16",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.