Provider Demographics
NPI:1164463766
Name:THOMAS, DAVID MARK (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARK
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S PERIMETER PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4128
Mailing Address - Country:US
Mailing Address - Phone:615-726-3603
Mailing Address - Fax:
Practice Address - Street 1:545 BRANDIES CIR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128
Practice Address - Country:US
Practice Address - Phone:615-295-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169249101YP2500X
TNLPC1910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100443270Medicaid
TN5441170Medicaid