Provider Demographics
NPI:1720177025
Name:HAMBURGEN, THOMAS C (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:HAMBURGEN
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 1:125 BANK ST STE 310
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4413
Mailing Address - Country:US
Mailing Address - Phone:406-549-7325
Mailing Address - Fax:
Practice Address - Street 1:125 BANK ST
Practice Address - Street 2:SUITE 310
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802
Practice Address - Country:US
Practice Address - Phone:406-549-7325
Practice Address - Fax:406-549-7559
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPSY-PSY-LIC-2504103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN079D2HAOtherBLUE CROSS BLUESHIELD