Healthcare Provider Details

I. General information

NPI: 1952786014
Provider Name (Legal Business Name): DR. TALLI HITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 ELKTON DR STE 301
COLORADO SPGS CO
80907-3884
US

IV. Provider business mailing address

1115 ELKTON DR STE 301
COLORADO SPGS CO
80907-3884
US

V. Phone/Fax

Practice location:
  • Phone: 719-357-6471
  • Fax:
Mailing address:
  • Phone: 193-576-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0005031
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: