Provider Demographics
NPI:1710043724
Name:CORWELL, THOMAS W (LMHC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:W
Last Name:CORWELL
Suffix:
Gender:M
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1841
Mailing Address - Country:US
Mailing Address - Phone:954-426-3262
Mailing Address - Fax:954-917-5360
Practice Address - Street 1:1265 S MILITARY TRL STE 110
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7688
Practice Address - Country:US
Practice Address - Phone:954-426-3262
Practice Address - Fax:954-917-5360
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH165OtherSTATE LICENSE
FLMT153OtherSTATE LICENSE