Basic Information
| Provider Information | |||||||||
| NPI: | 1043425424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DECK | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | CLAY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.A, C.A.C.-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 843 ROLLING MEADOWS DR | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490829548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176397066 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 316 E CHICAGO ST | ||||||||
| Address2: | |||||||||
| City: | COLDWATER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490362068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172795337 | ||||||||
| FaxNumber: | 5172795391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 120005 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.