Provider Demographics
NPI:1285094599
Name:TAFOYA, TOM
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:TAFOYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3747
Mailing Address - Country:US
Mailing Address - Phone:719-564-9039
Mailing Address - Fax:719-564-8752
Practice Address - Street 1:924 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3747
Practice Address - Country:US
Practice Address - Phone:719-564-9039
Practice Address - Fax:719-564-8752
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9923011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical