Healthcare Provider Details

I. General information

NPI: 1619134137
Provider Name (Legal Business Name): NEW BEHAVIORAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E WASHINGTON ST
APPLETON WI
54911-5490
US

IV. Provider business mailing address

200 E WASHINGTON ST P O BOX 8031
APPLETON WI
54911-5490
US

V. Phone/Fax

Practice location:
  • Phone: 920-996-1345
  • Fax: 920-739-0124
Mailing address:
  • Phone: 920-996-1345
  • Fax: 920-739-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateWI

VIII. Authorized Official

Name: DR. JONATHAN W THOMAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 920-996-1345