Provider Demographics
NPI:1518907278
Name:FAIN, THOMAS CARL (PHD, MS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CARL
Last Name:FAIN
Suffix:
Gender:M
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10641 HILLARY CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2842
Mailing Address - Country:US
Mailing Address - Phone:225-387-3325
Mailing Address - Fax:225-387-0140
Practice Address - Street 1:10641 HILLARY CT
Practice Address - Street 2:SUITE 1
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2842
Practice Address - Country:US
Practice Address - Phone:225-387-3325
Practice Address - Fax:225-387-0140
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPYR0261103TC0700X
TX2-1983-2103TC0700X
LA367103TC0700X, 103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
56004Medicare ID - Type Unspecified