Basic Information
| Provider Information | |||||||||
| NPI: | 1699972323 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROADHURST | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | JUDSON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHD, PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 KALISA WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076523508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889486789 | ||||||||
| FaxNumber: | 8773453501 | ||||||||
| Practice Location | |||||||||
| Address1: | 3131 S FEDERAL BLVD | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802362713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889486789 | ||||||||
| FaxNumber: | 8773453501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 79411 | CO | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103TC0700X | PSY.0004234 | CO | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.