Healthcare Provider Details

I. General information

NPI: 1255472320
Provider Name (Legal Business Name): THOMAS J ADAMS M.DIV., MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LAKEVIEW AVE
NATICK MA
01760-4270
US

IV. Provider business mailing address

30 LAKEVIEW AVE
NATICK MA
01760-4270
US

V. Phone/Fax

Practice location:
  • Phone: 818-640-1261
  • Fax: 509-497-0896
Mailing address:
  • Phone: 818-640-1261
  • Fax: 509-497-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC45852
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60229702
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMFC45852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: