Healthcare Provider Details

I. General information

NPI: 1821709205
Provider Name (Legal Business Name): TONY LEE THOMAS JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CURTISS RD
BARKSDALE AFB LA
71110-2425
US

IV. Provider business mailing address

243 CURTISS RD
BARKSDALE AFB LA
71110-2425
US

V. Phone/Fax

Practice location:
  • Phone: 318-456-6555
  • Fax:
Mailing address:
  • Phone: 318-456-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9377
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12934
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: