Provider Demographics
NPI:1891928479
Name:TERRANOVA, TIAH L (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:TIAH
Middle Name:L
Last Name:TERRANOVA
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3194 FAIRMONT DR UNIT 11B
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-1891
Mailing Address - Country:US
Mailing Address - Phone:970-515-3646
Mailing Address - Fax:970-221-0982
Practice Address - Street 1:3194 FAIRMONT DR UNIT 11B
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-1891
Practice Address - Country:US
Practice Address - Phone:970-515-3646
Practice Address - Fax:970-221-0982
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3686103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04582870Medicaid
CO383404Medicare PIN