MEDICARE: MR. MICHAEL J THOMAS JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1396907226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL J THOMAS JR.

Provider Business Mailing Address
First Line	:	8901 MAYFIELD CT
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63136
Country	:	US
Telephone Number	:	314-867-9562
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 MAYFIELD CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-5016
Country	:	US
Telephone Number	:	314-867-9562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	07/07/2008

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