Provider Demographics
NPI:1699459149
Name:RATHBUN, THOMAS EDWARD (LPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:RATHBUN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-5417
Mailing Address - Country:US
Mailing Address - Phone:937-846-6663
Mailing Address - Fax:
Practice Address - Street 1:5450 FAR HILLS AVE STE 205
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2346
Practice Address - Country:US
Practice Address - Phone:937-230-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2204757101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health