Provider Demographics
NPI:1073678074
Name:TISE, BARBARA CANDUS (LPC NCC)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:CANDUS
Last Name:TISE
Suffix:
Gender:F
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 ERINDALE DR
Mailing Address - Street 2:SUITE 124
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6740
Mailing Address - Country:US
Mailing Address - Phone:719-278-9535
Mailing Address - Fax:719-598-8605
Practice Address - Street 1:5525 ERINDALE DR
Practice Address - Street 2:SUITE 124
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6740
Practice Address - Country:US
Practice Address - Phone:719-278-9535
Practice Address - Fax:719-598-8605
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional