Provider Demographics
NPI:1821435306
Name:SMITH, THOMAS A (MS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1659
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-1659
Mailing Address - Country:US
Mailing Address - Phone:352-742-6170
Mailing Address - Fax:352-742-6008
Practice Address - Street 1:1300 S DUNCAN DR
Practice Address - Street 2:BLDG D
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4223
Practice Address - Country:US
Practice Address - Phone:352-742-6170
Practice Address - Fax:352-742-6008
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health