MEDICARE: TINA COLMENERO MA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC23442	AZ

General Provider Information

NPI Number	:	1982427282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA COLMENERO MA LPC

Provider Business Mailing Address
First Line	:	7445 N ORACLE RD STE 155
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-6367
Country	:	US
Telephone Number	:	520-791-9974
Fax Number	:

Provider Business Practice Location Address
First Line	:	7445 N ORACLE RD STE 155
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-6367
Country	:	US
Telephone Number	:	520-791-9974
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	11/05/2024

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