Provider Demographics
NPI:1811722374
Name:MAXWELL, THOMAS C
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:MAXWELL
Suffix:
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 1:18375 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-5737
Mailing Address - Country:US
Mailing Address - Phone:531-301-1277
Mailing Address - Fax:
Practice Address - Street 1:18375 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-5737
Practice Address - Country:US
Practice Address - Phone:531-301-1277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician