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General NPI Number Information
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NPI Number | 1659957546
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Entity Type | Individual
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Provider Name | THOMAS JOSEPH ITTOOP
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Gender | Male
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 3223 S LOOP 289
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City | LUBBOCK
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State | TX
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Zip | 79423-1337
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Country | US
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Telephone | 833-351-8255
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Fax |
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Provider Business Mailing Address
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Address Line | 115 ROSE ROW LN
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City | WINONA
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State | TX
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Zip | 75792-4912
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Country | US
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Telephone | 248-885-3641
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 341375
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License Number State | NY
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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 | V1493
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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