Provider Demographics
NPI:1407131360
Name:MEADE, THOMAS JOHN (LAC, SUDPT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOHN
Last Name:MEADE
Suffix:
Gender:M
Credentials:LAC, SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1492
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648-1492
Mailing Address - Country:US
Mailing Address - Phone:509-427-3850
Mailing Address - Fax:509-427-0188
Practice Address - Street 1:710 SW ROCK CREEK DR
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-4418
Practice Address - Country:US
Practice Address - Phone:509-427-3850
Practice Address - Fax:509-427-0188
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60615874171100000X
WACO61447187101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171100000XOther Service ProvidersAcupuncturist