=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538551148
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS HARWELL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2015
-----------------------------------------------------
Last Update Date | 02/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3100 SEYMOUR HWY #111
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76301-1850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-447-6573
-----------------------------------------------------
Fax | 940-766-0507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2010 SANTA FE ST #117
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76309-3459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-447-6573
-----------------------------------------------------
Fax | 940-766-0507
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 66303
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------