Provider Demographics
NPI:1215210091
Name:SMITH, THOMAS YOUNG (LSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:YOUNG
Last Name:SMITH
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5719
Mailing Address - Country:US
Mailing Address - Phone:402-601-5865
Mailing Address - Fax:970-240-3211
Practice Address - Street 1:314 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5719
Practice Address - Country:US
Practice Address - Phone:402-601-5865
Practice Address - Fax:970-240-3211
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW- 8971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical