Provider Demographics
NPI:1891416921
Name:WALTON, TAMMY RANEE (CAT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:RANEE
Last Name:WALTON
Suffix:
Gender:F
Credentials:CAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41305 OLSON RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81022-9804
Mailing Address - Country:US
Mailing Address - Phone:409-454-0648
Mailing Address - Fax:
Practice Address - Street 1:1969 42ND LANE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:CO
Practice Address - Zip Code:81022
Practice Address - Country:US
Practice Address - Phone:719-357-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACA0008030101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)