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General NPI Number Information
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NPI Number | 1477153187
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Entity Type | Individual
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Provider Name | DR. MALCOLM L THOMAS JR.
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Gender | Male
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 8400 N UNIVERSITY DR STE 114
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City | TAMARAC
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State | FL
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Zip | 33321-1700
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Country | US
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Telephone | 954-562-1955
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Fax | 954-510-6935
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Provider Business Mailing Address
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Address Line | 4960 NW 16TH ST
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City | LAUDERHILL
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State | FL
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Zip | 33313-5526
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Country | US
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Telephone | 954-562-1955
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1965
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH16592
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License Number State | FL
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