Provider Demographics
NPI:1821747411
Name:DREVO, TIFFANY LEANNE
Entity Type:Individual
Prefix:
First Name:TIFFANY LEANNE
Middle Name:
Last Name:DREVO
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 1:3301 W 144TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9511
Mailing Address - Country:US
Mailing Address - Phone:720-588-1200
Mailing Address - Fax:
Practice Address - Street 1:3301 W 144TH AVE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-9511
Practice Address - Country:US
Practice Address - Phone:720-588-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician