Provider Demographics
NPI:1184942658
Name:SUTTERFIELD, TAMMY ALEXIS (DBH)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:ALEXIS
Last Name:SUTTERFIELD
Suffix:
Gender:F
Credentials:DBH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 FOXTAIL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BLACKHAWK
Mailing Address - State:CO
Mailing Address - Zip Code:80422-8860
Mailing Address - Country:US
Mailing Address - Phone:303-807-7905
Mailing Address - Fax:
Practice Address - Street 1:656 FOXTAIL CIRCLE
Practice Address - Street 2:
Practice Address - City:BLACKHAWK
Practice Address - State:CO
Practice Address - Zip Code:80422-8860
Practice Address - Country:US
Practice Address - Phone:303-807-7905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-08
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60549708101YM0800X
TX15055101YP2500X
TXMT100515225700000X
CO0005763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist