Healthcare Provider Details

I. General information

NPI: 1831431337
Provider Name (Legal Business Name): THOMAS MIDGLEY MA, LAC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 30TH ST SUITE 207
BOULDER CO
80301-1088
US

IV. Provider business mailing address

1800 30TH ST SUITE 207
BOULDER CO
80301-1088
US

V. Phone/Fax

Practice location:
  • Phone: 424-646-3385
  • Fax:
Mailing address:
  • Phone: 424-646-3385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD0000346
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0012761
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: