Tiffany Renate Kilroy, LMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

39003699A Issued in IN

Practice address

55 Shore Dr
Portage, IN 46368-1008

Phone

(219) 230-8311

NPI assigned

Jan 30, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• State of Mind Therapy Services, LLC

  • Professional Counselor
  • Portage, IN
  • NPI 1083493761

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1679104343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 PLAZA DR., SUITE 2",
            "address_2": "PMB 279",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463041572",
            "telephone_number": "219-230-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 SHORE DR",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463681008",
            "telephone_number": "219-230-8311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILROY",
        "first_name": "TIFFANY",
        "middle_name": "RENATE",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-30",
        "last_updated": "2023-11-16",
        "certification_date": "2023-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39003699A",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IN",
            "license": "39003699A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Inderjit K Kapoor, M.D.
• Roza Karamacoski
• Abdul Kawamleh, MD
• Bishara Robert Khoury, D.O
• Courtney Kilgore
• Sharon Marie Davidson Kimes, APRN, FNP
• Elizabeth King, PHARMD
• Nicole L Kirkland, PTA
• Olesya Anna Klocek, OTR/L
• Teri Koch, MSN, RN, FNP-BC

• Professional Counselor in Portage, IN
• Providers in Portage, IN by specialty
• Professional Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.