Provider Demographics
NPI:1215124607
Name:THALER, GREG ALAN (PHD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:ALAN
Last Name:THALER
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 1:9900 E ILIFF AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3462
Mailing Address - Country:US
Mailing Address - Phone:303-636-5716
Mailing Address - Fax:
Practice Address - Street 1:10375 EAST HARVARD AVENUE
Practice Address - Street 2:SUITE 425
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3966
Practice Address - Country:US
Practice Address - Phone:303-636-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2304103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO40779Medicare PIN