Provider Demographics
NPI:1396020616
Name:VARNER, TIM (TIM VARNER, LCSW)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:VARNER
Suffix:
Gender:M
Credentials:TIM VARNER, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 QUINCE AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1109
Mailing Address - Country:US
Mailing Address - Phone:303-449-1329
Mailing Address - Fax:303-449-8637
Practice Address - Street 1:1530 QUINCE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1109
Practice Address - Country:US
Practice Address - Phone:303-449-1329
Practice Address - Fax:303-449-8637
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9910311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical