Provider Demographics
NPI:1659806693
Name:THOMAS BENDER LLC
Entity Type:Organization
Organization Name:THOMAS BENDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-681-1140
Mailing Address - Street 1:540 MAIN ST STE 108
Mailing Address - Street 2:DELTA, CO 81416
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1834
Mailing Address - Country:US
Mailing Address - Phone:505-681-1140
Mailing Address - Fax:970-874-2835
Practice Address - Street 1:540 MAIN ST STE 108
Practice Address - Street 2:DELTA, CO 81416
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-1834
Practice Address - Country:US
Practice Address - Phone:505-681-1140
Practice Address - Fax:970-874-2835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty