Provider Demographics
NPI:1548512395
Name:SCHIMON, TANYA ROE (LCSW)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:ROE
Last Name:SCHIMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:ROE
Other - Last Name:SCHIMON-BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6303 WETZEL AVE
Mailing Address - Street 2:BUILDING 1526
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4188
Mailing Address - Country:US
Mailing Address - Phone:719-526-1577
Mailing Address - Fax:
Practice Address - Street 1:6303 WETZEL AVE
Practice Address - Street 2:BUILDING 1526
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80913-4188
Practice Address - Country:US
Practice Address - Phone:719-526-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7741041C0700X
OK18401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical