Provider Demographics
NPI:1588849913
Name:DURUSSEL-WESTON, THOMAS EDWARD (LMSW, LMFT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:DURUSSEL-WESTON
Suffix:
Gender:M
Credentials:LMSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 COMBONI WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-9211
Mailing Address - Country:US
Mailing Address - Phone:734-242-5898
Mailing Address - Fax:734-242-6828
Practice Address - Street 1:3500 COMBONI WAY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-9211
Practice Address - Country:US
Practice Address - Phone:734-242-5898
Practice Address - Fax:734-242-6828
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010166861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical