Basic Information
| Provider Information | |||||||||
| NPI: | 1619178118 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANNEN | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | LORINDA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.S.W., CD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 CARPENTER RD | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805254248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706633500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 305 CARPENTER RD | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805254248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706633500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 02/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374J00000X | 6319 | CO | N | Nursing Service Related Providers | Doula | 1041C0700X | 144 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.