Basic Information
| Provider Information | |||||||||
| NPI: | 1750887725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WITMAN | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4860 ROBB ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800332162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032787418 | ||||||||
| FaxNumber: | 8883415050 | ||||||||
| Practice Location | |||||||||
| Address1: | 6010 TUTT BLVD | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809233600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889486789 | ||||||||
| FaxNumber: | 8773453501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2018 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW.00000942 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.