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General NPI Number Information
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NPI Number | 1861795650
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Entity Type | Individual
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Provider Name | THOMAS KELLY LABOMBARD LICSW
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Gender | Male
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 9395 LINDER WAY NW SUITE 202
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City | SILVERDALE
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State | WA
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Zip | 98383-9149
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Country | US
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Telephone | 360-434-3699
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Fax | 888-975-7504
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Provider Business Mailing Address
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Address Line | 8618 DICKEY RD NW
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City | SILVERDALE
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State | WA
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Zip | 98383-9214
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Country | US
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Telephone | 360-434-3699
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Fax | 888-975-7504
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW 60224639
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License Number State | WA
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