Healthcare Provider Details

I. General information

NPI: 1881651925
Provider Name (Legal Business Name): THOMAS T. LAWSON, PH.D. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E SUNBRIDGE DR
FAYETTEVILLE AR
72703-2830
US

IV. Provider business mailing address

118 E SUNBRIDGE DR
FAYETTEVILLE AR
72703-2830
US

V. Phone/Fax

Practice location:
  • Phone: 479-444-1400
  • Fax: 479-444-1422
Mailing address:
  • Phone: 479-444-1400
  • Fax: 479-444-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS T. LAWSON
Title or Position: OWNER
Credential: PH.D
Phone: 479-444-1400