Provider Demographics
NPI:1417640087
Name:SPALLA, TIMOTHY ALAN (LPCC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:SPALLA
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 QUEBEC ST STE 7
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-2322
Mailing Address - Country:US
Mailing Address - Phone:720-413-1747
Mailing Address - Fax:
Practice Address - Street 1:3401 QUEBEC ST STE 7
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-2322
Practice Address - Country:US
Practice Address - Phone:720-413-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0019933101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty