Provider Demographics
NPI:1215948112
Name:MAKO, THOMAS JOHN (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:MAKO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 BELMONT AVE
Mailing Address - Street 2:VA OUTPATIENT CLINIC
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-2401
Mailing Address - Country:US
Mailing Address - Phone:330-740-9200
Mailing Address - Fax:330-740-9249
Practice Address - Street 1:2031 BELMONT AVE
Practice Address - Street 2:VA OUTPATIENT CLINIC
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2401
Practice Address - Country:US
Practice Address - Phone:330-740-9200
Practice Address - Fax:330-740-9249
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4430103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling