Provider Demographics
NPI:1972924033
Name:BRIAN THOMAS PSY D PLLC
Entity Type:Organization
Organization Name:BRIAN THOMAS PSY D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:662-620-7102
Mailing Address - Street 1:144 S THOMAS ST
Mailing Address - Street 2:STE 103 ROOM 1
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5312
Mailing Address - Country:US
Mailing Address - Phone:662-231-8916
Mailing Address - Fax:662-620-7106
Practice Address - Street 1:144 S THOMAS ST STE 104A
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5337
Practice Address - Country:US
Practice Address - Phone:662-231-8916
Practice Address - Fax:662-620-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS40015103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty