Provider Demographics
NPI:1477658763
Name:TOMPKINS, DALE SAUL (PHD CACIII SAP)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:SAUL
Last Name:TOMPKINS
Suffix:
Gender:M
Credentials:PHD CACIII SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501
Mailing Address - Country:US
Mailing Address - Phone:970-241-2948
Mailing Address - Fax:970-242-4219
Practice Address - Street 1:1170 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-241-2948
Practice Address - Fax:970-242-4219
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1245103T00000X
CO5977103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO680010720OtherMEDICARE RAILROAD
COC89316Medicare UPIN
CO07012453Medicare ID - Type Unspecified