Provider Demographics
NPI:1376309195
Name:MINARIK, THOMAS JEFFERY II
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JEFFERY
Last Name:MINARIK
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70475 RAVINE ST
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-3137
Mailing Address - Country:US
Mailing Address - Phone:985-515-0690
Mailing Address - Fax:
Practice Address - Street 1:70475 RAVINE ST
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3137
Practice Address - Country:US
Practice Address - Phone:985-515-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health