MEDICARE: MR. THOMAS EDWARD DURUSSEL-WESTON LMSW, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801016686	MI

General Provider Information

NPI Number	:	1588849913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS EDWARD DURUSSEL-WESTON LMSW, LMFT

Provider Business Mailing Address
First Line	:	3500 COMBONI WAY
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48162-9211
Country	:	US
Telephone Number	:	734-242-5898
Fax Number	:	734-242-6828

Provider Business Practice Location Address
First Line	:	3500 COMBONI WAY
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48162-9211
Country	:	US
Telephone Number	:	734-242-5898
Fax Number	:	734-242-6828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	01/03/2008

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Directions to “ MR. THOMAS EDWARD DURUSSEL-WESTON LMSW, LMFT” Practice Location

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