Basic Information
| Provider Information | |||||||||
| NPI: | 1295288611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORTH | ||||||||
| FirstName: | THOMAS | ||||||||
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| NameSuffix: | SR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1517 MAYFIELD ST | ||||||||
| Address2: | |||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700655013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047012566 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3330 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048272701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2016 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.