Provider Demographics
NPI:1912041534
Name:UNSWORTH, THOMAS BRANDON (LMHC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BRANDON
Last Name:UNSWORTH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 FORUM PL
Mailing Address - Street 2:SUITE #7
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2330
Mailing Address - Country:US
Mailing Address - Phone:561-541-2005
Mailing Address - Fax:561-712-8070
Practice Address - Street 1:1650 PRESIDENTIAL WAY # A-506
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-1863
Practice Address - Country:US
Practice Address - Phone:561-541-2005
Practice Address - Fax:561-712-8070
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7626428-00Medicaid