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General NPI Number Information
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NPI Number | 1801066345
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Entity Type | Organization
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Legal Business Name | THOMAS J. CLUCAS, PHD, P.C.
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 125 BANK ST STE 310
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City | MISSOULA
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State | MT
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Zip | 59802-4413
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Country | US
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Telephone | 406-549-7325
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Fax |
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Provider Business Mailing Address
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Address Line | 125 BANK ST STE 310
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City | MISSOULA
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State | MT
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Zip | 59802-4413
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Country | US
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Telephone | 406-549-7325
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. THOMAS J. CLUCAS
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Credential | PHD
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Telephone | 406-549-7325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 186
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License Number State | MT
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