MEDICARE: TIFFANY BROOKS ARRIOLA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC010631	GA

General Provider Information

NPI Number	:	1326689472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY BROOKS ARRIOLA LPC

Provider Business Mailing Address
First Line	:	1721 BERKLEY AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81004-3203
Country	:	US
Telephone Number	:	678-699-9738
Fax Number	:

Provider Business Practice Location Address
First Line	:	1661 OCONNELL BLVD
Second Line	:
City	:	FT CARSON
State	:	CO
Zip	:	80913-5199
Country	:	US
Telephone Number	:	719-526-8064
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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