Provider Demographics
NPI:1720022973
Name:THOMAS, WILLIAM BRIAN (PSYD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRIAN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S THOMAS ST
Mailing Address - Street 2:STE 104A
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-231-8916
Mailing Address - Fax:662-259-8479
Practice Address - Street 1:144 S THOMAS ST STE 104A
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5337
Practice Address - Country:US
Practice Address - Phone:662-231-8916
Practice Address - Fax:662-259-8479
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS40015103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2476081Medicaid
MS2476081Medicaid
MS680000257Medicare ID - Type Unspecified