Healthcare Provider Details

I. General information

NPI: 1164118592
Provider Name (Legal Business Name): THOMAS GRANT HOWARTH MA, LPC, MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 E STATE HIGHWAY 7
NACOGDOCHES TX
75961-8918
US

IV. Provider business mailing address

1622 TERRACEWOOD ST
NACOGDOCHES TX
75965-2238
US

V. Phone/Fax

Practice location:
  • Phone: 936-615-7927
  • Fax: 866-875-5265
Mailing address:
  • Phone: 936-556-3874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number86467
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: