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General NPI Number Information
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NPI Number | 1891396693
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Entity Type | Organization
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Legal Business Name | TIDES CHANGING THERAPY
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 2949 FEDERAL BLVD # 205
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City | DENVER
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State | CO
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Zip | 80211-3741
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Country | US
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Telephone | 772-485-6301
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Fax |
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Provider Business Mailing Address
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Address Line | 2921 W 38TH AVE # 190
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City | DENVER
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State | CO
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Zip | 80211-2019
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Country | US
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Telephone | 772-485-6301
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, LCSW
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Name | SAMANTHA ALEXIS MILLER
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Credential | LCSW
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Telephone | 772-485-6301
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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 |
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License Number State |
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