Individual
MATHEW THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
801 E MAIN ST, TISHOMINGO, OK 73460-2351
(571) 331-7374
Mailing address
3722 HERITAGE PARK DR, SACHSE, TX 75048-4741
(571) 331-7374
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
OK
Other
Enumeration date
10/15/2014
Last updated
10/15/2014
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