Healthcare Provider Details

I. General information

NPI: 1194084277
Provider Name (Legal Business Name): THOMAS CHARLES HOUSTON D.MIN.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 S HARRISON ST SUITE 1200
DENVER CO
80210-3925
US

IV. Provider business mailing address

3776 S CHASE ST
DENVER CO
80235-2954
US

V. Phone/Fax

Practice location:
  • Phone: 720-254-0951
  • Fax:
Mailing address:
  • Phone: 720-254-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0558
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number0718
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: