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General NPI Number Information
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NPI Number | 1063960474
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Entity Type | Individual
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Provider Name | THOMAS MCCARTHY JR.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 525 PORTLAND AVE # MC963
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1533
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Country | US
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Telephone | 612-596-1223
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Fax |
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Provider Business Mailing Address
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Address Line | 525 PORTLAND AVE # MC963
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1533
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Country | US
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Telephone | 612-596-1223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State |
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