Provider Demographics
NPI:1225206584
Name:THOMAS E HOLSWORTH
Entity Type:Organization
Organization Name:THOMAS E HOLSWORTH
Other - Org Name:CENTER FOR PSYCHOLOGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:UMALI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD HSPP
Authorized Official - Phone:812-481-9988
Mailing Address - Street 1:4201 MANNHEIM RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9617
Mailing Address - Country:US
Mailing Address - Phone:812-481-9988
Mailing Address - Fax:812-481-9989
Practice Address - Street 1:4201 MANNHEIM RD
Practice Address - Street 2:SUITE G
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9617
Practice Address - Country:US
Practice Address - Phone:812-481-9988
Practice Address - Fax:812-481-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20090206103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100383740AMedicaid
IN100109690AMedicaid
IN200463710AMedicaid
IN200463500AMedicaid
IN141640Medicare PIN
IN200463710AMedicaid
IN200463500AMedicaid