Provider Demographics
NPI:1285656470
Name:THOMAS, JAMES AKIN III (MDIV, LP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:AKIN
Last Name:THOMAS
Suffix:III
Gender:M
Credentials:MDIV, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13480 45TH ST NE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-1083
Mailing Address - Country:US
Mailing Address - Phone:763-497-5518
Mailing Address - Fax:952-938-5853
Practice Address - Street 1:8700 W 36TH ST
Practice Address - Street 2:SUITE 7W
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3906
Practice Address - Country:US
Practice Address - Phone:952-938-5460
Practice Address - Fax:952-938-5853
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3410103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling