Provider Demographics
NPI:1083893630
Name:THORESON, KIRK LANG (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:LANG
Last Name:THORESON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 S JACKSON ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3801
Mailing Address - Country:US
Mailing Address - Phone:303-550-0030
Mailing Address - Fax:
Practice Address - Street 1:1776 S JACKSON ST
Practice Address - Street 2:SUITE 207
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3801
Practice Address - Country:US
Practice Address - Phone:303-550-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2891103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical