1114128428 NPI number — MR. ALTON BROOKS THOROUGHGOOD III M.ED., LMFT

Table of content: MR. ALTON BROOKS THOROUGHGOOD III M.ED., LMFT (NPI 1114128428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114128428 NPI number — MR. ALTON BROOKS THOROUGHGOOD III M.ED., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOROUGHGOOD
Provider First Name:
ALTON
Provider Middle Name:
BROOKS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.ED., LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114128428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 SOUTH GAYLORD ST.
Provider Second Line Business Mailing Address:
STE 206
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-217-6149
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 SOUTH GAYLORD ST.
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-217-6149
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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