Healthcare Provider Details

I. General information

NPI: 1942903315
Provider Name (Legal Business Name): THOMAS HEADLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 E ORCHARD RD STE 255
CENTENNIAL CO
80111-1722
US

IV. Provider business mailing address

141 SCHOOLEY RD
BAILEY CO
80421-1319
US

V. Phone/Fax

Practice location:
  • Phone: 720-263-2542
  • Fax:
Mailing address:
  • Phone: 720-263-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009924551
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: