Healthcare Provider Details

I. General information

NPI: 1376478503
Provider Name (Legal Business Name): TAMMY K THORVILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 OLD RANCH RD
COLORADO SPRINGS CO
80908-4528
US

IV. Provider business mailing address

63 WARD CT
LAKEWOOD CO
80228-5030
US

V. Phone/Fax

Practice location:
  • Phone: 888-506-9818
  • Fax:
Mailing address:
  • Phone: 888-506-9818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0024849
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: