Provider Demographics
NPI:1912160417
Name:FLEISHMAN, TINA Z (PSY D)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:Z
Last Name:FLEISHMAN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4242
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658-4242
Mailing Address - Country:US
Mailing Address - Phone:970-476-8032
Mailing Address - Fax:970-476-3654
Practice Address - Street 1:30 BENCHMARK ROAD
Practice Address - Street 2:SUITE 224
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620
Practice Address - Country:US
Practice Address - Phone:970-476-8032
Practice Address - Fax:970-476-3654
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1022103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical