Provider Demographics
NPI:1467624551
Name:HALKETT, THOMAS RICHMOND (M DIV)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RICHMOND
Last Name:HALKETT
Suffix:
Gender:M
Credentials:M DIV
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 564
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654
Mailing Address - Country:US
Mailing Address - Phone:207-263-6775
Mailing Address - Fax:207-255-6783
Practice Address - Street 1:8 PLEASANT BLVD
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654
Practice Address - Country:US
Practice Address - Phone:207-263-6775
Practice Address - Fax:207-255-6783
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC730101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor