Thomas William Clyburn III, PH.D.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH7314 Issued in FL

Practice address

318 Old Main St
Suite 21
Bradenton, FL 34205-7819

Phone

(941) 224-3800

Fax

(941) 745-1630

NPI assigned

Dec 3, 2008

Last updated

Apr 20, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Center of Revitalizing Psychiatry, P.C.Group PAC ID 0648239988, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Center of Revitalizing Psychiatry, P.C.

  • Psychiatry Physician
  • Rochelle Park, NJ
  • NPI 1356497960

  FL

  Medicare reassignment Care Compare group NPD
• Comprehensive Mental Health Solutions

  • Community/Behavioral Health Agency
  • Bradenton, FL
  • NPI 1801084306
  NPD (past) Authorized official
• Center of Revitalizing Psychiatry PC

  • Adult Mental Health Clinic/Center
  • Sarasota, FL
  • NPI 1538572854
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776643200000",
    "number": "1285879361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 MANATEE AVE W # 209",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342093952",
            "telephone_number": "941-224-3800",
            "fax_number": "941-745-1630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 OLD MAIN ST",
            "address_2": "SUITE 21",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342057819",
            "telephone_number": "941-224-3800",
            "fax_number": "941-745-1630"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2033 Wood St Ste 220",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342377927",
            "country_code": "US",
            "telephone_number": "941-677-3366",
            "fax_number": "941-677-3367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLYBURN",
        "first_name": "THOMAS",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-03",
        "last_updated": "2026-04-20",
        "certification_date": "2026-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH7314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.