Individual
THOMAS RICHARD MICHAEL BALKCOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1107 S JACKSON ST, BROOKHAVEN, MS 39601-4609
(601) 833-1507
Mailing address
1107 S JACKSON ST, BROOKHAVEN, MS 39601-4609
(601) 833-1507
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1181
MS
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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