Provider Demographics
NPI:1073194874
Name:FRAYER, TIANNA MARIE (MA)
Entity Type:Individual
Prefix:
First Name:TIANNA
Middle Name:MARIE
Last Name:FRAYER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TIANNA
Other - Middle Name:MARIE
Other - Last Name:SEAVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:4830 HUNTERS RUN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3102
Mailing Address - Country:US
Mailing Address - Phone:970-214-4799
Mailing Address - Fax:
Practice Address - Street 1:1425 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2871
Practice Address - Country:US
Practice Address - Phone:719-922-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-21-163914106S00000X
CO1-24-71802103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician