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General NPI Number Information
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NPI Number | 1033482955
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Entity Type | Organization
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Legal Business Name | THOMAS B. UNSWORTH P.A.
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 6269 NW GISELA ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-3866
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Country | US
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Telephone | 561-541-2005
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Fax | 772-879-2077
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Provider Business Mailing Address
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Address Line | 451 SW BETHANY DR SUITE 206
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1964
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Country | US
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Telephone | 561-541-2005
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Fax | 772-879-2077
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS BRANDON UNSWORTH
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Credential | LMHC
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Telephone | 561-541-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH4732
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License Number State | FL
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