Provider Demographics
NPI:1437145331
Name:DUVALL, THOMAS ODELL (PHD, LMHC, NCC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ODELL
Last Name:DUVALL
Suffix:
Gender:M
Credentials:PHD, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351-5000
Mailing Address - Country:US
Mailing Address - Phone:304-626-2500
Mailing Address - Fax:304-626-2604
Practice Address - Street 1:201 FCI LN
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-9500
Practice Address - Country:US
Practice Address - Phone:304-626-2500
Practice Address - Fax:304-626-2604
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005142101YP2500X
FLMH8470101YM0800X
FLPY9866103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health