Healthcare Provider Details

I. General information

NPI: 1053989095
Provider Name (Legal Business Name): JAMES THOMAS REGISTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5331 COMMERCIAL WAY STE 203
SPRING HILL FL
34606-1426
US

IV. Provider business mailing address

35052 WHISPERING OAKS BLVD
DADE CITY FL
33523-9415
US

V. Phone/Fax

Practice location:
  • Phone: 352-204-1169
  • Fax:
Mailing address:
  • Phone: 352-457-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: