Provider Demographics
NPI:1225744030
Name:MUSOKE, TOM (PROVIDER)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:MUSOKE
Suffix:
Gender:M
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8153 W FOREST GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-1500
Mailing Address - Country:US
Mailing Address - Phone:978-330-0849
Mailing Address - Fax:
Practice Address - Street 1:8153 W FOREST GROVE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-1500
Practice Address - Country:US
Practice Address - Phone:978-330-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty