Provider Demographics
NPI:1255486312
Name:AVERY, TOM (MSW)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:
Last Name:AVERY
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 1:1221 S CLARKSON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 S CLARKSON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1625
Practice Address - Country:US
Practice Address - Phone:720-227-0328
Practice Address - Fax:720-227-0329
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO989006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health