Provider Demographics
NPI:1366655219
Name:THOM, SEAN WILLIAM (BS)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:WILLIAM
Last Name:THOM
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:19466 GOLDEN MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-7593
Mailing Address - Country:US
Mailing Address - Phone:317-776-2751
Mailing Address - Fax:
Practice Address - Street 1:2626 E 46TH ST
Practice Address - Street 2:SUITE J
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2380
Practice Address - Country:US
Practice Address - Phone:317-475-9066
Practice Address - Fax:317-257-3602
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)