Provider Demographics
NPI:1932732500
Name:MARSHALL, THOMAS JAMES
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:MARSHALL
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 1:16109 W WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-3488
Mailing Address - Country:US
Mailing Address - Phone:602-614-2162
Mailing Address - Fax:
Practice Address - Street 1:16109 W WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3488
Practice Address - Country:US
Practice Address - Phone:602-614-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty