Basic Information
| Provider Information | |||||||||
| NPI: | 1942340971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTOON | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMFT JD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1640 | ||||||||
| Address2: | 1450 MAIN STREET | ||||||||
| City: | WEAVERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960931640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306231822 | ||||||||
| FaxNumber: | 5306234448 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | WEAVERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306231822 | ||||||||
| FaxNumber: | 5306234448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 05/06/2008 | ||||||||
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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 | 106H00000X | MFC34543 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.