Provider Demographics
NPI:1033323563
Name:BREWER, THOMAS GERALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GERALD
Last Name:BREWER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 W. LIBERTY RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9794
Mailing Address - Country:US
Mailing Address - Phone:734-994-9181
Mailing Address - Fax:
Practice Address - Street 1:3200 W. LIBERTY RD.
Practice Address - Street 2:SUITE A
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9794
Practice Address - Country:US
Practice Address - Phone:734-994-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009090103TC0700X, 103TC2200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680H1480600OtherBLUE CROSS BLUE SHIELD NO