Provider Demographics
NPI:1194564401
Name:KASABIAN, THOMAS MICHAEL
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:KASABIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 AUTUMN BREEZE CIR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3723
Mailing Address - Country:US
Mailing Address - Phone:850-485-8557
Mailing Address - Fax:
Practice Address - Street 1:1345 AUTUMN BREEZE CIR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3723
Practice Address - Country:US
Practice Address - Phone:850-485-8557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25215101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health