Basic Information
| Provider Information | |||||||||
| NPI: | 1659806693 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THOMAS BENDER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 MAIN ST STE 108 | ||||||||
| Address2: | DELTA, CO 81416 | ||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814161834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5056811140 | ||||||||
| FaxNumber: | 9708742835 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 MAIN ST STE 108 | ||||||||
| Address2: | DELTA, CO 81416 | ||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814161834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5056811140 | ||||||||
| FaxNumber: | 9708742835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2017 | ||||||||
| LastUpdateDate: | 04/27/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BENDER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5056811140 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0013088 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.