Provider Demographics
NPI:1477153187
Name:THOMAS, MALCOLM L JR
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:L
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5526
Mailing Address - Country:US
Mailing Address - Phone:954-562-1955
Mailing Address - Fax:
Practice Address - Street 1:8400 N UNIVERSITY DR STE 114
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1700
Practice Address - Country:US
Practice Address - Phone:954-562-1955
Practice Address - Fax:954-510-6935
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1965106H00000X
FLMH16592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist