Healthcare Provider Details

I. General information

NPI: 1780455873
Provider Name (Legal Business Name): LUKE TILDEN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7680 GODDARD ST STE 120
COLORADO SPRINGS CO
80920-8233
US

IV. Provider business mailing address

7680 GODDARD ST STE 120
COLORADO SPRINGS CO
80920-8233
US

V. Phone/Fax

Practice location:
  • Phone: 719-602-3816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0020227
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: