Provider Demographics
NPI:1811638737
Name:DODSON, THOMAS SAMUEL (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SAMUEL
Last Name:DODSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:SAMUEL
Other - Last Name:DODSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2911 W UINTAH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2487
Mailing Address - Country:US
Mailing Address - Phone:402-590-7000
Mailing Address - Fax:
Practice Address - Street 1:3141 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4094
Practice Address - Country:US
Practice Address - Phone:719-327-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0005768261QV0200X
CO0005768103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA