Provider Demographics
NPI:1225237860
Name:THOMAS, THOMAS D (MS, LPC, CSAT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MS, LPC, CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 GEORGE ST
Mailing Address - Street 2:SUITE LL6
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-2712
Mailing Address - Country:US
Mailing Address - Phone:920-338-0331
Mailing Address - Fax:920-338-0348
Practice Address - Street 1:416 GEORGE ST
Practice Address - Street 2:SUITE LL6
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-2712
Practice Address - Country:US
Practice Address - Phone:920-338-0331
Practice Address - Fax:920-338-0348
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1246-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1246-125OtherSTATE LICENSE