Provider Demographics
NPI:1467501643
Name:MASSOLL, THOMAS O (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:O
Last Name:MASSOLL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-1706
Mailing Address - Country:US
Mailing Address - Phone:817-358-8500
Mailing Address - Fax:817-545-9847
Practice Address - Street 1:2516 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-1706
Practice Address - Country:US
Practice Address - Phone:817-358-8500
Practice Address - Fax:817-545-9847
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000096101YM0800X
TX10615101YM0800X
TX000234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist