Tiare Kaena Poleschook, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0019412 Issued in CO

Practice address

11831 Ridge Pkwy Apt 1518
Broomfield, CO 80021-6519

Phone

(720) 891-5200

NPI assigned

Sep 14, 2022

Last updated

Sep 14, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1952023152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11831 RIDGE PKWY APT 1518",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800216519",
            "telephone_number": "720-891-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11831 RIDGE PKWY APT 1518",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800216519",
            "telephone_number": "720-891-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLESCHOOK",
        "first_name": "TIARE",
        "middle_name": "KAENA",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-14",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "0019412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tiarepoleschook@boulderemotionalwellness.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11831 Ridge Pkwy Apt 1518",
            "city": "Broomfield",
            "state": "CO",
            "country_code": "US",
            "postal_code": "800216519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Broomfield, CO
• Providers in Broomfield, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.