Basic Information
| Provider Information | |||||||||
| NPI: | 1093800559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SILLS | ||||||||
| FirstName: | THERON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1306 11TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703472343 | ||||||||
| FaxNumber: | 9703533906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1306 11TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703472343 | ||||||||
| FaxNumber: | 9703533906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 05/12/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 15418 | CO | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 2084P0800X | 15418 | CO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 15418 | 01 | CO | M.D. | OTHER |