Provider Demographics
NPI:1033140520
Name:THOMSON, THOMAS RAY (MED)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RAY
Last Name:THOMSON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 NW 50TH ST
Mailing Address - Street 2:SUITE 241 C
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8086
Mailing Address - Country:US
Mailing Address - Phone:405-408-5760
Mailing Address - Fax:405-418-0324
Practice Address - Street 1:2212 NW 50TH ST
Practice Address - Street 2:SUITE 241 C
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8086
Practice Address - Country:US
Practice Address - Phone:405-408-5760
Practice Address - Fax:405-418-0324
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health