Provider Demographics
NPI:1801016225
Name:HOLBROOK, THOMAS MITCHELL (MDIV)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MITCHELL
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1008
Mailing Address - Country:US
Mailing Address - Phone:859-985-0745
Mailing Address - Fax:
Practice Address - Street 1:121 S CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1008
Practice Address - Country:US
Practice Address - Phone:859-985-0745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYCFBPC-KY0040101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral