Provider Demographics
NPI:1700952330
Name:FOLLETT, THOMAS MICHAEL (MSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:FOLLETT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 SUPERIOR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595
Mailing Address - Country:US
Mailing Address - Phone:515-832-6644
Mailing Address - Fax:515-832-6653
Practice Address - Street 1:1703 SUPERIOR
Practice Address - Street 2:SUITE 3
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595
Practice Address - Country:US
Practice Address - Phone:515-832-6644
Practice Address - Fax:515-832-6653
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05253104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
04675OtherBCBS
04675Medicare ID - Type Unspecified