Provider Demographics
NPI:1932449493
Name:SMITH, THOMAS A (PHD, LMHC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD, LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 NE 17TH WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3428
Mailing Address - Country:US
Mailing Address - Phone:786-202-0962
Mailing Address - Fax:954-522-2970
Practice Address - Street 1:871 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-1731
Practice Address - Country:US
Practice Address - Phone:954-567-7141
Practice Address - Fax:954-703-2029
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP-5643101YA0400X
FLMH9909101YM0800X
FLMT2721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist