Provider Demographics
NPI:1154937605
Name:FENDEL, TANIA ALEXIS (MA, LAC)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:ALEXIS
Last Name:FENDEL
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:HUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:501 GARFIELD ST
Mailing Address - Street 2:UNIT 304
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206
Mailing Address - Country:US
Mailing Address - Phone:303-524-0262
Mailing Address - Fax:
Practice Address - Street 1:50 S STEELE ST STE 950
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2843
Practice Address - Country:US
Practice Address - Phone:303-524-0262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002132101YA0400X
CONLC.0105806101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty