Provider Demographics
NPI:1922119551
Name:SCOFIELD, THOMAS R (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:SCOFIELD
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 AVENUE A
Mailing Address - Street 2:SUITE I
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8159
Mailing Address - Country:US
Mailing Address - Phone:308-234-5644
Mailing Address - Fax:308-234-5652
Practice Address - Street 1:3810 AVENUE A
Practice Address - Street 2:SUITE I
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8159
Practice Address - Country:US
Practice Address - Phone:308-234-5644
Practice Address - Fax:308-234-5652
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080829226Medicaid
NE84338OtherBC/BS