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General NPI Number Information
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NPI Number | 1710791694
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Entity Type | Individual
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Provider Name | TAVINIA NOVELLA TUCKER WEST MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 2860 S CIRCLE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-4113
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Country | US
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Telephone | 888-816-1805
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Fax |
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Provider Business Mailing Address
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Address Line | 918 N INSTITUTE ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-2738
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Country | US
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Telephone | 210-374-6142
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09931253
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License Number State | CO
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