MEDICARE: TAMARA SMITH

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

General Provider Information

NPI Number	:	1497373815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA SMITH

Provider Business Mailing Address
First Line	:	2602 ALTON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2677
Country	:	US
Telephone Number	:	720-635-9479
Fax Number	:

Provider Business Practice Location Address
First Line	:	2602 ALTON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2677
Country	:	US
Telephone Number	:	720-635-9479
Fax Number	:

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

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	07/13/2020

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Directions to “ TAMARA SMITH ” Practice Location

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