Healthcare Provider Details

I. General information

NPI: 1477478931
Provider Name (Legal Business Name): MR. THOMAS AZIZ ELMASRI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22428 SPRINGFLOWER DR
GOLDEN CO
80401-8033
US

IV. Provider business mailing address

22428 SPRINGFLOWER DR
GOLDEN CO
80401-8033
US

V. Phone/Fax

Practice location:
  • Phone: 682-410-6625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0023832
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: