Provider Demographics
NPI:1760497440
Name:GIVLER, THOMAS L (DSW)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:GIVLER
Suffix:
Gender:M
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4273 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 260 E
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6748
Mailing Address - Country:US
Mailing Address - Phone:505-830-9307
Mailing Address - Fax:505-830-9307
Practice Address - Street 1:4273 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 260 E
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6748
Practice Address - Country:US
Practice Address - Phone:505-830-9307
Practice Address - Fax:505-830-9307
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-00691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00094624Medicaid