Provider Demographics
NPI:1710791694
Name:TUCKER WEST, TAVINIA NOVELLA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:TAVINIA
Middle Name:NOVELLA
Last Name:TUCKER WEST
Suffix:
Gender:
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:TAVINIA
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:918 N INSTITUTE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2738
Mailing Address - Country:US
Mailing Address - Phone:210-374-6142
Mailing Address - Fax:
Practice Address - Street 1:2860 S CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4113
Practice Address - Country:US
Practice Address - Phone:888-816-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099312531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical