Provider Demographics
NPI:1285840447
Name:SHIELDS, THOMAS BRENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BRENT
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 OAK ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1870
Mailing Address - Country:US
Mailing Address - Phone:541-951-5180
Mailing Address - Fax:
Practice Address - Street 1:208 OAK ST STE 102
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1870
Practice Address - Country:US
Practice Address - Phone:541-951-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1603103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical