Provider Demographics
NPI:1609108521
Name:ANDERSON, TAMI ANNETTE (MS)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:ANNETTE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:TAMI
Other - Middle Name:ANNETTE
Other - Last Name:ANDERSON ENGLEHORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:7015 SCULPIN CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-9621
Mailing Address - Country:US
Mailing Address - Phone:970-988-0645
Mailing Address - Fax:
Practice Address - Street 1:2629 REDWING RD
Practice Address - Street 2:SUITE #316
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6315
Practice Address - Country:US
Practice Address - Phone:970-988-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO#10440101Y00000X, 101YM0800X, 101YP1600X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional