Provider Demographics
NPI:1437677143
Name:GILDENZOPH, TAMERA LYNN (MA)
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:LYNN
Last Name:GILDENZOPH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TAMERA
Other - Middle Name:LYNN
Other - Last Name:BATES-GILDENZOPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:715 HORIZON DR STE 225
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:CO
Practice Address - Zip Code:80480-0000
Practice Address - Country:US
Practice Address - Phone:970-723-0055
Practice Address - Fax:970-723-4732
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health