Individual
SHANNAN TIPHARETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3470 BALTIMORE AVE, PUEBLO, CO 81008-1520
(719) 369-3781
Mailing address
3470 BALTIMORE AVE, PUEBLO, CO 81008-1520
(719) 369-3781
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACB.0008677
CO
Other
Enumeration date
09/24/2020
Last updated
09/24/2020
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