Provider Demographics
NPI:1568406577
Name:LISHMAN, THOMAS (MS, LPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:LISHMAN
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E JOPPA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3107
Mailing Address - Country:US
Mailing Address - Phone:443-862-2646
Mailing Address - Fax:
Practice Address - Street 1:200 E JOPPA RD STE 200
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3107
Practice Address - Country:US
Practice Address - Phone:443-862-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004045101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA651006-01OtherBC/BS OF MD. CARE FIRST
PA50058541OtherCAPITAL BLUE CROSS