Provider Demographics
NPI:1023542560
Name:RITTENMEYER, TYSON (MA, LPC, MT-BC)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:
Last Name:RITTENMEYER
Suffix:
Gender:M
Credentials:MA, LPC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5252
Mailing Address - Country:US
Mailing Address - Phone:303-245-1020
Mailing Address - Fax:
Practice Address - Street 1:1320 PEARL ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5252
Practice Address - Country:US
Practice Address - Phone:303-245-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health