Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor | 1492 | OK |
NPI | 1144661729 |
---|---|
Provider Name | Scott William Thomas |
First Address | Tulsa, OK 74133-1356 |
Second Address | Broken Arrow, OK 74012-6503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2013 |
Last Update Date | 11/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1492 | OKLAHOMA STATE DEPARTMENT OF HEALTH/LPC LICENSE (01) | OK |
722 | OKLAHOMA STATE DEPARTMENT OF HEALTH/LMFT LICENSE (01) | OK |