Basic Information
| Provider Information | |||||||||
| NPI: | 1376766972 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLETTA | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 N 17TH AVE | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806319584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703472120 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1170 W ASH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805504783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703472120 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | ACD.0000498 | CO | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | LPC.0005606 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.