Provider Demographics
NPI:1821030537
Name:MUNNELL, THOMAS CHARLES (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHARLES
Last Name:MUNNELL
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 1:2101 S BLACKHAWK ST
Mailing Address - Street 2:SUITE # 250
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1492
Mailing Address - Country:US
Mailing Address - Phone:303-751-2710
Mailing Address - Fax:303-696-1292
Practice Address - Street 1:2101 S BLACKHAWK ST
Practice Address - Street 2:SUITE # 250
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1492
Practice Address - Country:US
Practice Address - Phone:303-751-2710
Practice Address - Fax:303-696-1292
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9880161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88766Medicare ID - Type Unspecified