Healthcare Provider Details

I. General information

NPI: 1235890872
Provider Name (Legal Business Name): TAMORA TANNIEHILL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMORA TANNIEHILL LPC

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 MITCHELL LN
BOULDER CO
80301-2273
US

IV. Provider business mailing address

3340 MITCHELL LN
BOULDER CO
80301-2273
US

V. Phone/Fax

Practice location:
  • Phone: 720-641-7580
  • Fax:
Mailing address:
  • Phone: 720-641-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0017726
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: