Provider Demographics
NPI:1962571547
Name:VERKEST, THOMAS A (MA,LLP,)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:VERKEST
Suffix:
Gender:M
Credentials:MA,LLP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 BALMORAL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-3001
Mailing Address - Country:US
Mailing Address - Phone:586-463-7869
Mailing Address - Fax:
Practice Address - Street 1:24715 LITTLE MACK AVE
Practice Address - Street 2:STE. 200
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3207
Practice Address - Country:US
Practice Address - Phone:586-777-9000
Practice Address - Fax:586-777-0823
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008935103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical