Provider Demographics
NPI:1962714477
Name:MCMINN, THOMAS CARL (LPC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CARL
Last Name:MCMINN
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 1:321 AUTUMN LANE
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-8713
Mailing Address - Country:US
Mailing Address - Phone:864-305-5322
Mailing Address - Fax:800-340-0223
Practice Address - Street 1:321 AUTUMN LANE
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-8713
Practice Address - Country:US
Practice Address - Phone:864-305-5322
Practice Address - Fax:800-340-0223
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC4063101Y00000X, 101YM0800X
SC4063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty