Provider Demographics
NPI:1508862780
Name:THOMAS, LARRY DWAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DWAYNE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 S DAY ST
Mailing Address - Street 2:STE 405
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-0901
Mailing Address - Country:US
Mailing Address - Phone:979-830-7080
Mailing Address - Fax:979-830-7124
Practice Address - Street 1:2211 S DAY ST
Practice Address - Street 2:STE 405
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-0901
Practice Address - Country:US
Practice Address - Phone:979-830-7080
Practice Address - Fax:979-830-7124
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-2195103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86277PMedicare ID - Type Unspecified