Provider Demographics
NPI:1215687728
Name:SANTACASA, TATUM KIERA (MS, LMFT)
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:KIERA
Last Name:SANTACASA
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:TATUM
Other - Middle Name:
Other - Last Name:SANTACASA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TATUM SANTACASA
Mailing Address - Street 1:20000 MITCHELL PL UNIT 3
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-7229
Mailing Address - Country:US
Mailing Address - Phone:602-920-0216
Mailing Address - Fax:
Practice Address - Street 1:14241 E 4TH AVE STE 5-140
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8733
Practice Address - Country:US
Practice Address - Phone:720-843-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-27
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0002056106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1000695264Medicaid