Healthcare Provider Details

I. General information

NPI: 1093300758
Provider Name (Legal Business Name): TAMARA DIANE MICHELLE PINTILY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 TENNYSON ST
DENVER CO
80212-3029
US

IV. Provider business mailing address

2950 TENNYSON ST
DENVER CO
80212-3029
US

V. Phone/Fax

Practice location:
  • Phone: 303-433-2541
  • Fax:
Mailing address:
  • Phone: 303-433-2541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD..0002399
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09929428
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: