Provider Demographics
NPI:1588274880
Name:DELL, TANA (LCSW)
Entity type:Individual
Prefix:
First Name:TANA
Middle Name:
Last Name:DELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12160 DEERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5390
Mailing Address - Country:US
Mailing Address - Phone:303-579-6672
Mailing Address - Fax:
Practice Address - Street 1:12160 DEERFIELD WAY
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5390
Practice Address - Country:US
Practice Address - Phone:303-579-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYLCSW-860OtherLCSW
COCSW-48OtherLCSW