Healthcare Provider Details

I. General information

NPI: 1568494532
Provider Name (Legal Business Name): DELBERT R THOMAS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 BROWNS LN
JONESBORO AR
72401
US

IV. Provider business mailing address

2707 BROWNS LN
JONESBORO AR
72401
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-4939
  • Fax: 870-972-4911
Mailing address:
  • Phone: 870-972-4939
  • Fax: 870-972-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number94-18P
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number94-18P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: