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General NPI Number Information
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NPI Number | 1225216161
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Entity Type | Individual
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Provider Name | JAMES THEODORE THOMAS II LPC - MHSP
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Gender | Male
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 1114 MARLIN RD
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City | MEMPHIS
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State | TN
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Zip | 38116-6384
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Country | US
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Telephone | 901-268-2290
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Fax | 901-344-0058
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Provider Business Mailing Address
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Address Line | 1114 MARLIN RD
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City | MEMPHIS
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State | TN
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Zip | 38116-6384
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Country | US
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Telephone | 901-268-2290
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Fax | 901-344-0058
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2269
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License Number State | TN
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