Provider Demographics
NPI:1548657877
Name:DR. SUNDA FRIEDMAN TEBOCKHORST PSYCHOLOGICL SERVICES, LTD
Entity type:Organization
Organization Name:DR. SUNDA FRIEDMAN TEBOCKHORST PSYCHOLOGICL SERVICES, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN TEBOCKHORST
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:720-387-8458
Mailing Address - Street 1:588 N US HIGHWAY 287 STE 200
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2615
Mailing Address - Country:US
Mailing Address - Phone:720-387-8458
Mailing Address - Fax:
Practice Address - Street 1:588 N US HIGHWAY 287 STE 200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2615
Practice Address - Country:US
Practice Address - Phone:720-387-8458
Practice Address - Fax:720-306-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4820101YP2500X
103T00000X
CO4121103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty