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Individual

DR. TOM L HAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
515 PURDUE AVE, SAINT LOUIS, MO 63130-4134
(314) 518-8445
Mailing address
515 PURDUE AVE, SAINT LOUIS, MO 63130-4134
(314) 518-8445

Taxonomy

Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
6301006996
MI
103TC1900X
Counseling Psychologist
Primary
6301006996
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6301006996
DEPT OF COMMUNITY HEALTH: BOARD OF PSYCHOLOGY
MI
Enumeration date
07/23/2009
Last updated
07/23/2009
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