Provider Demographics
NPI:1457733941
Name:TYRRELL, TANYA M (MSW, LCSW, LAC, ACS)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:M
Last Name:TYRRELL
Suffix:
Gender:F
Credentials:MSW, LCSW, LAC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:419-695-0004
Practice Address - Street 1:1600 SPECHT POINT RD STE 105
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4311
Practice Address - Country:US
Practice Address - Phone:970-494-5891
Practice Address - Fax:970-494-5895
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001264101YA0400X
ACS.31731041C0700X
COCSW.099251711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)