Individual
DR. JACK E. THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2108 S LOCUST CT, BLOOMINGTON, IN 47401-6751
(812) 325-6877
Mailing address
2108 S LOCUST CT, BLOOMINGTON, IN 47401-6751
(812) 325-6877
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20010356A
IN
Other
Enumeration date
07/26/2007
Last updated
07/26/2007
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