Provider Demographics
NPI:1083821326
Name:THAMES, MATTHEW R (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:THAMES
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 POST RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3839
Mailing Address - Country:US
Mailing Address - Phone:601-750-8977
Mailing Address - Fax:
Practice Address - Street 1:2508 LAKELAND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9502
Practice Address - Country:US
Practice Address - Phone:601-664-0455
Practice Address - Fax:601-664-1675
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional