Healthcare Provider Details

I. General information

NPI: 1518907278
Provider Name (Legal Business Name): THOMAS CARL FAIN PH.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10641 HILLARY CT SUITE 1
BATON ROUGE LA
70810-2842
US

IV. Provider business mailing address

10641 HILLARY CT SUITE 1
BATON ROUGE LA
70810-2842
US

V. Phone/Fax

Practice location:
  • Phone: 225-387-3325
  • Fax: 225-387-0140
Mailing address:
  • Phone: 225-387-3325
  • Fax: 225-387-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPYR0261
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2-1983-2
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number367
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number367
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: