MEDICARE: MR. TOM S. ALSABROOK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	734	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6291847	OTHER	AL	UBH BASIC SERVICES
2	6292847	OTHER	AL	UBH PLUS SERVICES

General Provider Information

NPI Number	:	1215989629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOM S. ALSABROOK LPC

Provider Business Mailing Address
First Line	:	475 MYCHAEL LN
Second Line	:
City	:	CENTREVILLE
State	:	AL
Zip	:	35042-4446
Country	:	US
Telephone Number	:	334-683-9957
Fax Number	:	334-683-4114

Provider Business Practice Location Address
First Line	:	104 EDWARDS ST
Second Line	:
City	:	MARION
State	:	AL
Zip	:	36756-2304
Country	:	US
Telephone Number	:	334-683-9957
Fax Number	:	334-683-4114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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