Provider Demographics
NPI:1053493825
Name:CURRAN, THOMAS FREDERICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FREDERICK
Last Name:CURRAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:NORTHBANK
Other - Middle Name:COUNSELING
Other - Last Name:SERVICES, P.C.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:110 MILL ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2818
Mailing Address - Country:US
Mailing Address - Phone:810-750-1044
Mailing Address - Fax:810-750-0987
Practice Address - Street 1:110 MILL ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2818
Practice Address - Country:US
Practice Address - Phone:810-750-1044
Practice Address - Fax:810-750-0987
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003045103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B54521Medicare ID - Type Unspecified