Provider Demographics
NPI:1164782686
Name:NERGUIZIAN, TIFFANY M (LPC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:M
Last Name:NERGUIZIAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:M
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 ELKTON DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-314-9228
Mailing Address - Fax:719-570-0386
Practice Address - Street 1:1115 ELKTON DR
Practice Address - Street 2:SUITE 300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-314-9228
Practice Address - Fax:719-570-0386
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health