Healthcare Provider Details

I. General information

NPI: 1144661729
Provider Name (Legal Business Name): SCOTT WILLIAM THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 S MAIN ST
BROKEN ARROW OK
74012-6503
US

IV. Provider business mailing address

6369 S 86TH EAST AVE
TULSA OK
74133-1356
US

V. Phone/Fax

Practice location:
  • Phone: 918-991-5771
  • Fax:
Mailing address:
  • Phone: 918-991-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1492
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number722
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: