Provider Demographics
NPI:1881823037
Name:WAHLUND, THOMAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:WAHLUND
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 1:77 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073-9532
Mailing Address - Country:US
Mailing Address - Phone:724-840-1226
Mailing Address - Fax:866-277-1901
Practice Address - Street 1:77 VALLEY RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01073-9532
Practice Address - Country:US
Practice Address - Phone:413-341-0342
Practice Address - Fax:866-277-1901
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300010OtherMBHP
MA1300881Medicaid