Provider Demographics
NPI:1033482955
Name:THOMAS B. UNSWORTH P.A.
Entity type:Organization
Organization Name:THOMAS B. UNSWORTH P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:UNSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:561-541-2005
Mailing Address - Street 1:451 SW BETHANY DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1964
Mailing Address - Country:US
Mailing Address - Phone:561-541-2005
Mailing Address - Fax:772-879-2077
Practice Address - Street 1:6269 NW GISELA ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3866
Practice Address - Country:US
Practice Address - Phone:561-541-2005
Practice Address - Fax:772-879-2077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS B. UNSWORTH P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty