Provider Demographics
NPI:1912333162
Name:PALLAS, TIFFANY (LCSW, LAC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PALLAS
Suffix:
Gender:
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 ALYBAR DR UNIT 4C
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-1546
Mailing Address - Country:US
Mailing Address - Phone:970-402-6793
Mailing Address - Fax:
Practice Address - Street 1:3101 ALYBAR DR UNIT 4C
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-1546
Practice Address - Country:US
Practice Address - Phone:970-402-6793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0006981101YA0400X
COCSW099244211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical