Provider Demographics
NPI:1235912627
Name:MACNABB, THOMAS ALAN
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:MACNABB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12122 COLORADO BLVD APT F308
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-4231
Mailing Address - Country:US
Mailing Address - Phone:719-200-4484
Mailing Address - Fax:
Practice Address - Street 1:12122 COLORADO BLVD APT F308
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-4231
Practice Address - Country:US
Practice Address - Phone:719-200-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician