Provider Demographics
NPI:1225216161
Name:THOMAS, JAMES THEODORE II (LPC - MHSP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THEODORE
Last Name:THOMAS
Suffix:II
Gender:M
Credentials:LPC - MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 MARLIN RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6384
Mailing Address - Country:US
Mailing Address - Phone:901-268-2290
Mailing Address - Fax:901-344-0058
Practice Address - Street 1:1114 MARLIN RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6384
Practice Address - Country:US
Practice Address - Phone:901-268-2290
Practice Address - Fax:901-344-0058
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional