Provider Demographics
NPI:1477553089
Name:NORRIS, THOMAS ARLO (ED D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ARLO
Last Name:NORRIS
Suffix:
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 DELMORA DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-8335
Mailing Address - Country:US
Mailing Address - Phone:903-240-7514
Mailing Address - Fax:866-849-9384
Practice Address - Street 1:414 E LOOP 281 STE 7
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7931
Practice Address - Country:US
Practice Address - Phone:903-240-7514
Practice Address - Fax:866-849-9384
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32447103T00000X
TX13814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170254002Medicaid
TX170254001Medicaid