Healthcare Provider Details

I. General information

NPI: 1417267196
Provider Name (Legal Business Name): ARTHUR THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 S PORTAGE PATH
AKRON OH
44320
US

IV. Provider business mailing address

415 S PORTAGE PATH
AKRON OH
44320
US

V. Phone/Fax

Practice location:
  • Phone: 330-253-4597
  • Fax:
Mailing address:
  • Phone: 330-253-4597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number90102
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: