Provider Demographics
NPI:1275707655
Name:JOHNSON, THOMAS MALCOLM (PHD LMHC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MALCOLM
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11663 COUNTRYWAY BLVD
Mailing Address - Street 2:PATIENTS FIRST FAMILY MEDICINE
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2739
Mailing Address - Country:US
Mailing Address - Phone:727-580-4806
Mailing Address - Fax:
Practice Address - Street 1:11663 COUNTRYWAY BLVD
Practice Address - Street 2:PATIENTS FIRST FAMILY MEDICINE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2739
Practice Address - Country:US
Practice Address - Phone:727-580-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health