Healthcare Provider Details

I. General information

NPI: 1104621226
Provider Name (Legal Business Name): THOMAS JAMES BILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W SUPERIOR ST BLDG SUITE601
DULUTH MN
55802-1803
US

IV. Provider business mailing address

306 W SUPERIOR ST BLDG SUITE601
DULUTH MN
55802-1803
US

V. Phone/Fax

Practice location:
  • Phone: 218-522-4469
  • Fax: 218-520-3038
Mailing address:
  • Phone: 218-522-4469
  • Fax: 218-520-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4837
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4837
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: