Provider Demographics
NPI:1255895793
Name:THOMAS, JOHN MARK (LMFT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARK
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5122
Mailing Address - Country:US
Mailing Address - Phone:219-462-3765
Mailing Address - Fax:
Practice Address - Street 1:750 RANSOM RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-8973
Practice Address - Country:US
Practice Address - Phone:219-464-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000216A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35000216AOtherINDIANA PROFESSIONAL LICENSING NUMBER