Provider Demographics
NPI:1235890872
Name:TANNIEHILL, TAMORA (MA)
Entity Type:Individual
Prefix:
First Name:TAMORA
Middle Name:
Last Name:TANNIEHILL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TAMORA
Other - Middle Name:
Other - Last Name:TANNIEHILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:750 S LAFAYETTE DR APT J201
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3640
Mailing Address - Country:US
Mailing Address - Phone:720-641-7580
Mailing Address - Fax:
Practice Address - Street 1:3340 MITCHELL LN
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2273
Practice Address - Country:US
Practice Address - Phone:720-641-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional