Provider Demographics
NPI:1093810665
Name:PAPPAS, TOM C (LCSW)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:C
Last Name:PAPPAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 KIRKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FT. COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2017
Mailing Address - Country:US
Mailing Address - Phone:970-472-1315
Mailing Address - Fax:
Practice Address - Street 1:1750 25TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-353-3373
Practice Address - Fax:970-353-3374
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9912781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA3506Medicare ID - Type Unspecified