Provider Demographics
NPI:1437359841
Name:BABAUTA, THOMAS (MSW, ACSW,QCSW,IMFT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BABAUTA
Suffix:
Gender:M
Credentials:MSW, ACSW,QCSW,IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E CHALAN SANTO PAPA
Mailing Address - Street 2:REFLECTION CENTER STE. 102
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-5161
Mailing Address - Country:US
Mailing Address - Phone:671-477-5715
Mailing Address - Fax:671-477-5716
Practice Address - Street 1:222 E CHALAN SANTO PAPA
Practice Address - Street 2:REFLECTION CENTER STE. 102
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-5161
Practice Address - Country:US
Practice Address - Phone:671-477-5715
Practice Address - Fax:671-477-5716
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUIMF-0054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist