MEDICARE: MICHAEL THOMAS LMFT

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	101YM0800X	Mental Health Counselor	LF00001354	WA

General Provider Information

NPI Number	:	1871646083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL THOMAS LMFT

Provider Business Mailing Address
First Line	:	2370 130TH AVE NE STE 106
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-1770
Country	:	US
Telephone Number	:	425-885-2833
Fax Number	:	425-885-2833

Provider Business Practice Location Address
First Line	:	2370 130TH AVE NE STE 106
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-1770
Country	:	US
Telephone Number	:	425-885-2833
Fax Number	:	425-885-2833

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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