Healthcare Provider Details

I. General information

NPI: 1124344205
Provider Name (Legal Business Name): THOMAS CHARLES CAUGHLAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 PROFESSIONAL PL STE 101
COLORADO SPRINGS CO
80904-8125
US

IV. Provider business mailing address

PO BOX 911057
DENVER CO
80291-1057
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-6850
  • Fax: 719-776-6855
Mailing address:
  • Phone: 888-269-7001
  • Fax: 303-764-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.00001992
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: