Tiffany Marie Babcock, CADC,QHEIC

Key facts

NPI

1124142807

Entity type

Individual (NPI type 1)

Primary specialty

Addiction (Substance Use Disorder) Counselor 101YA0400X

Practice address

2323 Windish Dr
Galesburg, IL 61401-9780

Phone

(309) 344-4233

Fax

(309) 344-4281

NPI assigned

Mar 19, 2007

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

Other identifiers

Other names

• Ms. Tiffany Marie Shannon Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 15, 2009.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239753600000",
    "number": "1124142807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 105",
            "city": "ROSEVILLE",
            "state": "IL",
            "postal_code": "614730105",
            "telephone_number": "319-750-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 WINDISH DR",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614019780",
            "telephone_number": "309-344-4233",
            "fax_number": "309-344-4281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BABCOCK",
        "first_name": "TIFFANY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "CADC,QHEIC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-19",
        "last_updated": "2009-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEIN ORGANIZATION",
            "identifier": "370984175",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "SHANNON",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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