MEDICARE: KITRA C. THOMAS

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	101YP2500X	Professional Counselor	4391-125	WI

General Provider Information

NPI Number	:	1649138561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KITRA C. THOMAS

Provider Business Mailing Address
First Line	:	2021 GROVE AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53405-3843
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1143 WARWICK WAY UNIT A
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-5661
Country	:	US
Telephone Number	:	844-973-0635
Fax Number	:	262-583-4014

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

Provider Enumeration Date	:	01/10/2026
Last Update Date	:	01/13/2026

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