Provider Demographics
NPI:1417505140
Name:SHUMPERT, TIERRA DANIELLE
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:DANIELLE
Last Name:SHUMPERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10177 STATION WAY APT 434
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6859
Mailing Address - Country:US
Mailing Address - Phone:720-288-1523
Mailing Address - Fax:
Practice Address - Street 1:2206 VICTOR ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7400
Practice Address - Country:US
Practice Address - Phone:303-617-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor