Basic Information
| Provider Information | |||||||||
| NPI: | 1598055311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SINGLETON | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | L.P., LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17845 ISLE AVE | ||||||||
| Address2: | |||||||||
| City: | LAKEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550448730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528928996 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3450 OLEARY LN | ||||||||
| Address2: | |||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551232340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514540114 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2011 | ||||||||
| LastUpdateDate: | 04/13/2011 | ||||||||
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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 | 103T00000X | LP3394 | MN | Y | Behavioral Health & Social Service Providers | Psychologist | 1041C0700X | 12495 | MN | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.