Healthcare Provider Details

I. General information

NPI: 1477142081
Provider Name (Legal Business Name): TANNER OLIVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6075 S QUEBEC ST STE 200
CENTENNIAL CO
80111-4535
US

IV. Provider business mailing address

5300 DTC PKWY STE 450
GREENWOOD VILLAGE CO
80111-3027
US

V. Phone/Fax

Practice location:
  • Phone: 720-390-6932
  • Fax:
Mailing address:
  • Phone: 720-390-6932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09929693
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: