Provider Demographics
NPI:1396379962
Name:SMITH, THOMAS THORNSBERRY (LMFT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:THORNSBERRY
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WELLS AVE S UNIT D
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2786
Mailing Address - Country:US
Mailing Address - Phone:206-276-2637
Mailing Address - Fax:
Practice Address - Street 1:306 WELLS AVE S UNIT D
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2786
Practice Address - Country:US
Practice Address - Phone:206-276-2637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001551106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty