Provider Demographics
NPI:1407175037
Name:THOMASSON, ANDREW (LCSW, CACII)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:THOMASSON
Suffix:
Gender:M
Credentials:LCSW, CACII
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 964
Mailing Address - Street 2:
Mailing Address - City:GRAND LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80447-0964
Mailing Address - Country:US
Mailing Address - Phone:970-531-6173
Mailing Address - Fax:970-887-2293
Practice Address - Street 1:191 E AGATE AVE
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446
Practice Address - Country:US
Practice Address - Phone:970-531-6173
Practice Address - Fax:970-887-2293
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW17391041C0700X, 1041C0700X
COACB6696101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)