Provider Demographics
NPI:1700193513
Name:VAN DEREN, TIFFANY BAUCUM (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:BAUCUM
Last Name:VAN DEREN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10941 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9361
Mailing Address - Country:US
Mailing Address - Phone:303-818-2889
Mailing Address - Fax:303-841-9224
Practice Address - Street 1:1385 S COLORADO BLVD
Practice Address - Street 2:BLDG. A SUITE 210
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3304
Practice Address - Country:US
Practice Address - Phone:303-818-2889
Practice Address - Fax:303-841-9224
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional