Provider Demographics
NPI:1730360983
Name:TEBOCKHORST, SUNDA FRIEDMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:SUNDA
Middle Name:FRIEDMAN
Last Name:TEBOCKHORST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6680 GUNPARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3349
Mailing Address - Country:US
Mailing Address - Phone:720-387-8458
Mailing Address - Fax:720-208-0666
Practice Address - Street 1:6680 GUNPARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3349
Practice Address - Country:US
Practice Address - Phone:720-387-8458
Practice Address - Fax:720-208-0666
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4820101Y00000X, 101YM0800X, 101YP2500X
CO4121103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional