Provider Demographics
NPI:1720695992
Name:DR. SUNDA FRIEDMAN TEBOCKHORST PSYCHOLOGICAL SERVICES, LTD.
Entity type:Organization
Organization Name:DR. SUNDA FRIEDMAN TEBOCKHORST PSYCHOLOGICAL SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDA
Authorized Official - Middle Name:FRIEDMAN
Authorized Official - Last Name:TEBOCKHORST
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:720-387-8458
Mailing Address - Street 1:588 N US HIGHWAY 287 STE 200
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2615
Mailing Address - Country:US
Mailing Address - Phone:720-387-8458
Mailing Address - Fax:720-306-5190
Practice Address - Street 1:1099 MAIN AVE STE 320
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5159
Practice Address - Country:US
Practice Address - Phone:720-387-8458
Practice Address - Fax:720-306-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty