Provider Demographics
NPI:1902278534
Name:SCHWARTZ, THOMAS DALE (MCP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DALE
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 VISTA DR
Mailing Address - Street 2:APT. 4313
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2499
Mailing Address - Country:US
Mailing Address - Phone:832-449-3644
Mailing Address - Fax:
Practice Address - Street 1:3101 VISTA DR
Practice Address - Street 2:APT. 4313
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2499
Practice Address - Country:US
Practice Address - Phone:832-449-3644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health