Provider Demographics
NPI:1750199527
Name:COLGAN, THOMAS PETER (PCLC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:PETER
Last Name:COLGAN
Suffix:
Gender:M
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 SW HIGGINS AVE STE E
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1430
Mailing Address - Country:US
Mailing Address - Phone:781-771-8940
Mailing Address - Fax:
Practice Address - Street 1:619 SW HIGGINS AVE STE E
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1430
Practice Address - Country:US
Practice Address - Phone:781-771-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-64440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health