Provider Demographics
NPI:1639178056
Name:SLOUGH, THOMAS L (LPA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:SLOUGH
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 KNICKERBOCKER RD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-8823
Mailing Address - Country:US
Mailing Address - Phone:325-942-7531
Mailing Address - Fax:325-942-7532
Practice Address - Street 1:3471 KNICKERBOCKER RD
Practice Address - Street 2:SUITE 508
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-8823
Practice Address - Country:US
Practice Address - Phone:325-942-7531
Practice Address - Fax:325-942-7532
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12487101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8130BHOtherBLUECROSSBLUESHIELD