Provider Demographics
NPI:1043596745
Name:BIRCHFIELD, THOMAS RICHARD (MS, CRC, LPC-INTERN)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RICHARD
Last Name:BIRCHFIELD
Suffix:
Gender:M
Credentials:MS, CRC, LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 BEVERLY DR W
Mailing Address - Street 2:APT 2178
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76132-5821
Mailing Address - Country:US
Mailing Address - Phone:817-841-9214
Mailing Address - Fax:
Practice Address - Street 1:6100 WESTERN PL
Practice Address - Street 2:STE 408
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4600
Practice Address - Country:US
Practice Address - Phone:817-735-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional