Provider Demographics
NPI:1295939213
Name:TAMBONE, GINA MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MICHELLE
Last Name:TAMBONE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 N ACADEMY BLVD STE 312
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5347
Mailing Address - Country:US
Mailing Address - Phone:719-598-8560
Mailing Address - Fax:719-426-2969
Practice Address - Street 1:2790 N ACADEMY BLVD STE 312
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5347
Practice Address - Country:US
Practice Address - Phone:719-598-8560
Practice Address - Fax:719-426-2969
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0011679OtherDORA
15382602OtherCAQH