Provider Demographics
NPI:1184955478
Name:VALLIANOS, TANYA MARIA (LPC)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MARIA
Last Name:VALLIANOS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:MARIA
Other - Last Name:VALLIANOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATR
Mailing Address - Street 1:PO BOX 496
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522
Mailing Address - Country:US
Mailing Address - Phone:970-420-9504
Mailing Address - Fax:
Practice Address - Street 1:201 S. COLLEGE AVE
Practice Address - Street 2:#207
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-420-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC#3823101YP2500X
NCC#234715101YP2500X
ATR#07-066221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist