Provider Demographics
NPI:1194912105
Name:LARRY D THOMAS PHD INC
Entity type:Organization
Organization Name:LARRY D THOMAS PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:979-830-7080
Mailing Address - Street 1:2211 S DAY ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-0901
Mailing Address - Country:US
Mailing Address - Phone:979-830-7080
Mailing Address - Fax:979-830-7124
Practice Address - Street 1:2211 S DAY ST
Practice Address - Street 2:SUITE 405
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5583
Practice Address - Country:US
Practice Address - Phone:979-830-7080
Practice Address - Fax:979-830-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12195103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0802399-01Medicaid
TX00255NMedicare PIN