MEDICARE: TIFFANY TESORIERO 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	101YM0800X	Mental Health Counselor	006930-1	NY
2	101YP2500X	Professional Counselor	LPC.0013820	CO

General Provider Information

NPI Number	:	1528433166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY TESORIERO LPC

Provider Business Mailing Address
First Line	:	2975 BROADMOOR VALLEY RD STE 103A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4466
Country	:	US
Telephone Number	:	719-428-2275
Fax Number	:

Provider Business Practice Location Address
First Line	:	2975 BROADMOOR VALLEY RD STE 103A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4466
Country	:	US
Telephone Number	:	719-428-2275
Fax Number	:

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

Provider Enumeration Date	:	12/08/2015
Last Update Date	:	02/17/2023

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