Provider Demographics
NPI:1679089791
Name:SUTTON, TIARA
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 GOSS CIR E APT 1
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6635
Mailing Address - Country:US
Mailing Address - Phone:480-440-1564
Mailing Address - Fax:
Practice Address - Street 1:2244 GOSS CIR E APT 1
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6635
Practice Address - Country:US
Practice Address - Phone:480-440-1564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician