Healthcare Provider Details

I. General information

NPI: 1285880393
Provider Name (Legal Business Name): TAMI L BEAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMI L HARRIS

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S PARKSIDE DRIVE
COLORADO SPRINGS CO
80910
US

IV. Provider business mailing address

220 RUSKIN DR
COLORADO SPRINGS CO
80910
US

V. Phone/Fax

Practice location:
  • Phone: 719-572-6340
  • Fax: 719-447-4792
Mailing address:
  • Phone: 719-572-6100
  • Fax: 719-572-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1637
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: