Provider Demographics
NPI:1285073221
Name:PRITCHARD, THOMAS (MED)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:PRITCHARD
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1612
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-1612
Mailing Address - Country:US
Mailing Address - Phone:312-203-1498
Mailing Address - Fax:
Practice Address - Street 1:2509 RESEARCH BLVD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-8108
Practice Address - Country:US
Practice Address - Phone:312-203-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health