Thomas Richard Michael Balkcom, LPC
Individual provider Active NPI Counselor · Brookhaven, MS
NPI 1457570939 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1457570939
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 1181 (MS)
- Practice address
- 1107 S Jackson St
Brookhaven, MS 39601-4609 - Phone
- (601) 833-1507
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 1181 | MS | Yes |
Addresses
Primary practice location
1107 S Jackson St
Brookhaven, MS 39601-4609
Mailing address
1107 S Jackson St
Brookhaven, MS 39601-4609
Phone (601) 833-1507
Other providers in Brookhaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.