Basic Information
| Provider Information | |||||||||
| NPI: | 1760962955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAPIA-FUSELIER | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | LUIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PHD, CRC, LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1283 KELLY JOHNSON BLVD | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809203925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194136776 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1283 KELLY JOHNSON BLVD | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809203925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194136776 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2018 | ||||||||
| LastUpdateDate: | 10/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0017322 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.