Healthcare Provider Details

I. General information

NPI: 1609108521
Provider Name (Legal Business Name): TAMI ANNETTE ANDERSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMI ANNETTE ANDERSON ENGLEHORN M.S.

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 REDWING RD SUITE #316
FORT COLLINS CO
80526-6315
US

IV. Provider business mailing address

7015 SCULPIN CT
FORT COLLINS CO
80526-9621
US

V. Phone/Fax

Practice location:
  • Phone: 970-988-0645
  • Fax:
Mailing address:
  • Phone: 970-988-0645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number#10440
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number#10440
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number#10440
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number#10440
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number#10440
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: