Provider Demographics
NPI:1821140716
Name:COLYER, THOMAS THEODORE (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:THEODORE
Last Name:COLYER
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 1:610 7TH ST E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5047
Mailing Address - Country:US
Mailing Address - Phone:406-755-7370
Mailing Address - Fax:406-755-7277
Practice Address - Street 1:612 7TH STREET EAST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-755-7370
Practice Address - Fax:406-755-7277
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT156103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM000005202Medicare PIN
MTR09986Medicare UPIN