Provider Demographics
NPI:1649556242
Name:GREENFIELD, THOMAS ALVIN (MED, LPC, LADC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALVIN
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:MED, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-5240
Mailing Address - Country:US
Mailing Address - Phone:405-222-8267
Mailing Address - Fax:405-222-8267
Practice Address - Street 1:2204 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-5240
Practice Address - Country:US
Practice Address - Phone:405-222-8267
Practice Address - Fax:405-222-8267
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4617101YP2500X
OK925101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)