| Surviving To Thriving Llc | |
|
3194 Fairmont Dr Unit 11b Wellington CO 80549-1891 | |
| (970) 515-3646 | |
| Not Available |
| Full Name | Surviving To Thriving Llc |
|---|---|
| Speciality | Psychologist |
| Location | 3194 Fairmont Dr Unit 11b, Wellington, Colorado |
| Authorized Official Name and Position | Tiah Terranova (FULL MEMBER) |
| Authorized Official Contact | 9705153646 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Surviving To Thriving Llc 3194 Fairmont Dr Unit 11b Wellington CO 80549-1891 Ph: (970) 515-3646 | Surviving To Thriving Llc 3194 Fairmont Dr Unit 11b Wellington CO 80549-1891 Ph: (970) 515-3646 |
| NPI Number | 1346901360 |
|---|---|
| Provider Enumeration Date | 01/02/2022 |
| Last Update Date | 01/14/2022 |
| Certification Date | 01/14/2022 |
| Medicare PECOS PAC ID | 0941692743 |
|---|---|
| Medicare Enrollment ID | O20220127001248 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346901360 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tiah L Terranova |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891928479 PECOS PAC ID: 6204085319 Enrollment ID: I20121005000044 |
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