Provider Demographics
NPI:1467583583
Name:THOME, PENELOPE LEE (MA)
Entity Type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:LEE
Last Name:THOME
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 GLEN AYR DR
Mailing Address - Street 2:SUITE #5
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-3051
Mailing Address - Country:US
Mailing Address - Phone:720-533-4880
Mailing Address - Fax:720-533-4880
Practice Address - Street 1:1510 GLEN AYR DR
Practice Address - Street 2:SUITE #5
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3051
Practice Address - Country:US
Practice Address - Phone:720-533-4880
Practice Address - Fax:720-533-4880
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCAC-II 5338101YA0400X
COLPC2438101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional