Provider Demographics
NPI:1952023152
Name:POLESCHOOK, TIARE KAENA (LPCC)
Entity Type:Individual
Prefix:
First Name:TIARE
Middle Name:KAENA
Last Name:POLESCHOOK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11831 RIDGE PKWY APT 1518
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-6519
Mailing Address - Country:US
Mailing Address - Phone:720-891-5200
Mailing Address - Fax:
Practice Address - Street 1:11831 RIDGE PKWY APT 1518
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-6519
Practice Address - Country:US
Practice Address - Phone:720-891-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health