Provider Demographics
NPI:1467648113
Name:WINDHAM, THOMAS LAWSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LAWSON
Last Name:WINDHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 ILIFF ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-7022
Mailing Address - Country:US
Mailing Address - Phone:303-499-2740
Mailing Address - Fax:720-381-6784
Practice Address - Street 1:2830 ILIFF ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-7022
Practice Address - Country:US
Practice Address - Phone:303-499-2740
Practice Address - Fax:720-381-6784
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC810202Medicare PIN