MEDICARE: TREE TALL COUNSELING, LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1861961336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREE TALL COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1410 PRAIRIE RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2956
Country	:	US
Telephone Number	:	719-210-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 N HANCOCK AVE STE 5N
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2672
Country	:	US
Telephone Number	:	719-210-0168
Fax Number	:

Authorized Official
Title or Position	:	LEAD THERAPIST
Name	:	MARY ALISON BUTLER
Credential	:	LCSW
Telephone Number	:	719-210-0168

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	11/14/2018

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