Healthcare Provider Details

I. General information

NPI: 1134044076
Provider Name (Legal Business Name): TIA URBAN LPCC, CAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14190 E JEWELL AVE STE 7
AURORA CO
80012-5659
US

IV. Provider business mailing address

11183 E BALTIC PL
AURORA CO
80014-1083
US

V. Phone/Fax

Practice location:
  • Phone: 720-288-0450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0023751
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: