Provider Demographics
NPI:1588105613
Name:SPRAGUE, THOMAS
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:SPRAGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:670 ROUTE 6A
Mailing Address - Street 2:
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1436
Mailing Address - Country:US
Mailing Address - Phone:508-503-2435
Mailing Address - Fax:508-224-7956
Practice Address - Street 1:670 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1436
Practice Address - Country:US
Practice Address - Phone:508-503-2435
Practice Address - Fax:508-224-7956
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor