Provider Demographics
NPI:1164617957
Name:MCCORD, THOMAS HALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HALL
Last Name:MCCORD
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 1:3468 MT DIABLO BLVD STE B203
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-7120
Mailing Address - Country:US
Mailing Address - Phone:510-286-7598
Mailing Address - Fax:
Practice Address - Street 1:3468 MT DIABLO BLVD STE B203
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-7120
Practice Address - Country:US
Practice Address - Phone:510-286-7598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8855103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPH0088550Medicare PIN