Provider Demographics
NPI:1356668560
Name:THOMAS, TERRY OLIVER (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:OLIVER
Last Name:THOMAS
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 1:1818 AVENUE OF AMERICA
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4530
Mailing Address - Country:US
Mailing Address - Phone:318-998-2700
Mailing Address - Fax:318-998-2703
Practice Address - Street 1:1818 AVENUE OF AMERICA
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4530
Practice Address - Country:US
Practice Address - Phone:318-998-2700
Practice Address - Fax:318-998-2703
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1192103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling