Healthcare Provider Details

I. General information

NPI: 1790879658
Provider Name (Legal Business Name): WILLIAM THOMAS LAWHORN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

IV. Provider business mailing address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5828
  • Fax: 614-257-5418
Mailing address:
  • Phone: 614-257-5828
  • Fax: 614-257-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number4991
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4991
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4991
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: