Provider Demographics
NPI:1154390466
Name:CARLIN, THOMAS DONNELLY (EDD,NCSP, LCPC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DONNELLY
Last Name:CARLIN
Suffix:
Gender:M
Credentials:EDD,NCSP, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FRIENDSHIP LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTANA CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9804
Mailing Address - Country:US
Mailing Address - Phone:406-449-5555
Mailing Address - Fax:406-442-8090
Practice Address - Street 1:11 FRIENDSHIP LN
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTANA CITY
Practice Address - State:MT
Practice Address - Zip Code:59634-9804
Practice Address - Country:US
Practice Address - Phone:406-449-5555
Practice Address - Fax:406-442-8090
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCPC 392101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT740413OtherBLUE CROSS/BLUE SHIELD