=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285656470
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES AKIN THOMAS III M.DIV., LP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8700 W 36TH ST SUITE 7W
-----------------------------------------------------
City | ST LOUIS PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55426-3906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-938-5460
-----------------------------------------------------
Fax | 952-938-5853
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13480 45TH ST NE
-----------------------------------------------------
City | SAINT MICHAEL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55376-1083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-497-5518
-----------------------------------------------------
Fax | 952-938-5853
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | LP3410
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------