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General NPI Number Information
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NPI Number | 1407973449
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Entity Type | Organization
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Legal Business Name | JACK R. TOMLINSON
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 2410 9TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4033
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Country | US
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Telephone | 940-723-0012
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Fax | 940-723-2058
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Provider Business Mailing Address
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Address Line | 2410 9TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4033
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Country | US
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Telephone | 940-723-0012
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Fax | 940-723-2058
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. JUDY L YOUNG
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Credential |
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Telephone | 940-723-0012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 740
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C6537
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 898
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License Number State | TX
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