Provider Demographics
NPI:1538551148
Name:HARWELL, THOMAS
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:HARWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:HARWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2010 SANTA FE ST
Mailing Address - Street 2:#117
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-3459
Mailing Address - Country:US
Mailing Address - Phone:940-447-6573
Mailing Address - Fax:940-766-0507
Practice Address - Street 1:3100 SEYMOUR HWY
Practice Address - Street 2:#111
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-1850
Practice Address - Country:US
Practice Address - Phone:940-447-6573
Practice Address - Fax:940-766-0507
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66303101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)