Individual ProviderTiffany MitchellSocial WorkerBehavioral Health & Social Service ProvidersPractice Address800 Zorn Ave, Louisville, KY 40206-1433(502) 356-0390PECOS EnrollmentBased on the most recent information from CMS, provider Tiffany Mitchell does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1821435033Provider TypeIndividualFull NameMitchell, TiffanyGenderFemaleSole ProprietorNoEnumeration Date5/29/2013Last Updated10/15/2019Contact InformationPractice LocationPractice Address800 Zorn Ave, Louisville, KY 40206-1433Phone(502) 356-0390FaxUnlisted FaxMailing LocationMailing Address101 W Muhammad Ali Blvd, Louisville, KY 40202-1423PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense253646KentuckyCode104100000XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense7405Kentucky