Provider Demographics
NPI:1003384843
Name:CLARKE, TOMAS (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TOMAS
Middle Name:
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6790 E CEDAR AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1170
Mailing Address - Country:US
Mailing Address - Phone:720-446-8783
Mailing Address - Fax:
Practice Address - Street 1:3035 W 25TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4635
Practice Address - Country:US
Practice Address - Phone:720-446-8783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0016653101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor