Doctor Name: | DR. SANDRA THEBAUD |
NPI Number: | 1003238296 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 3300 |
Business Practice Address: | 50 South Steele St Suite 435 Denver, CO - 80206 |
Business Phone Number: | 7203788080 |
Business Fax Number: | |
Mailing Address: | Po Box 5754, DENVER |
State: | CO |
Postal Code: | 80217 |
Phone Number: | 7203788080 |
Fax Number: | |
NPI Enumeration Date: | 01/08/2014 |
NPI Last Update Date: | 01/08/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 3300 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |