Provider Demographics
NPI:1144672122
Name:MUNHOLLAND, THOMAS EUGENE (LAC, MAC, LPCC, CRC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EUGENE
Last Name:MUNHOLLAND
Suffix:
Gender:M
Credentials:LAC, MAC, LPCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2403
Mailing Address - Country:US
Mailing Address - Phone:970-235-0645
Mailing Address - Fax:
Practice Address - Street 1:1433 W 29TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2403
Practice Address - Country:US
Practice Address - Phone:970-235-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0021361101YP2500X
COACD.0002056101YA0400X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0333945Medicaid