Provider Demographics
NPI:1720114986
Name:DAVIDSON, THOMAS BRADFORD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BRADFORD
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 E PRENTICE AVE
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2744
Mailing Address - Country:US
Mailing Address - Phone:303-796-8451
Mailing Address - Fax:303-741-2878
Practice Address - Street 1:8000 E PRENTICE AVE
Practice Address - Street 2:SUITE B-4
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2744
Practice Address - Country:US
Practice Address - Phone:303-796-8451
Practice Address - Fax:303-741-2878
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO666-81103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07104490Medicaid
CO07104490Medicaid