Provider Demographics
NPI:1225566870
Name:THOMAS, ZACHARY MITCHELL (MSW)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:MITCHELL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-2379
Mailing Address - Country:US
Mailing Address - Phone:970-874-2753
Mailing Address - Fax:970-399-7005
Practice Address - Street 1:360 E 8TH ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2379
Practice Address - Country:US
Practice Address - Phone:970-874-2753
Practice Address - Fax:970-399-7005
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CO099266011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA