Provider Demographics
NPI:1215045497
Name:TAINEY, PHYLLIS SHEILA (MSW LCSW CAC III)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:SHEILA
Last Name:TAINEY
Suffix:
Gender:F
Credentials:MSW LCSW CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 LINCOLN CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:303-776-6376
Mailing Address - Fax:303-776-6376
Practice Address - Street 1:1479 LINCOLN CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:303-776-6376
Practice Address - Fax:303-776-6376
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5260101YA0400X
CO9913371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)