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1871100719
SHANNAN TIPHARETH
PUEBLO, CO
NPI
1871100719
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CO ACB.0008677)
Enumeration Date
2020-09-24
Last Update Date
2020-09-24
Business Address
SHANNAN TIPHARETH
3470 BALTIMORE AVE
PUEBLO, CO 81008-1520
Phone number: 719-369-3781
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Mailing Address
SHANNAN TIPHARETH
3470 BALTIMORE AVE
PUEBLO, CO 81008-1520
Phone number: 719-369-3781
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