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General NPI Number Information
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NPI Number | 1972924033
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Entity Type | Organization
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Legal Business Name | BRIAN THOMAS PSY D PLLC
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 144 S THOMAS ST STE 104A
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City | TUPELO
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State | MS
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Zip | 38801-5337
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Country | US
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Telephone | 662-231-8916
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Fax | 662-620-7106
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Provider Business Mailing Address
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Address Line | 144 S THOMAS ST STE 103 ROOM 1
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City | TUPELO
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State | MS
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Zip | 38801-5312
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Country | US
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Telephone | 662-231-8916
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Fax | 662-620-7106
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN THOMAS
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Credential | PSY.D
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Telephone | 662-620-7102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 40015
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License Number State | MS
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