Provider Demographics
NPI:1447459482
Name:POUNDERS, THOMAS JEFFERSON III (LCSW, MDIV, PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JEFFERSON
Last Name:POUNDERS
Suffix:III
Gender:M
Credentials:LCSW, MDIV, PHD
Other - Prefix:DR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:POUNDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4421 W OKMULGEE ST # 328
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4651
Mailing Address - Country:US
Mailing Address - Phone:580-320-5287
Mailing Address - Fax:918-577-3701
Practice Address - Street 1:1011 HONOR HEIGHTS DR
Practice Address - Street 2:MAIL CODE 115
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1318
Practice Address - Country:US
Practice Address - Phone:918-577-3000
Practice Address - Fax:918-577-3648
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLCSW 3620104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKLCSW 3620OtherOKLAHOMA STATE BOARD OF LICENSED SOCIAL WORKERS
OKCERT CASE MGR 9983OtherOKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES