Provider Demographics
NPI:1932339041
Name:HAM, TOM L (PHD)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:L
Last Name:HAM
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 1:515 PURDUE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4134
Mailing Address - Country:US
Mailing Address - Phone:314-518-8445
Mailing Address - Fax:
Practice Address - Street 1:515 PURDUE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4134
Practice Address - Country:US
Practice Address - Phone:314-518-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006996103TA0400X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301006996OtherDEPT OF COMMUNITY HEALTH: BOARD OF PSYCHOLOGY