Healthcare Provider Details

I. General information

NPI: 1629308614
Provider Name (Legal Business Name): KATHY THOMAS, PH.D., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 N LINDSAY RD SUITE 111
GILBERT AZ
85234-5807
US

IV. Provider business mailing address

33 N LINDSAY RD SUITE 111
GILBERT AZ
85234-5807
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-6447
  • Fax: 480-497-4166
Mailing address:
  • Phone: 480-497-6447
  • Fax: 480-497-4166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3634
License Number StateAZ

VIII. Authorized Official

Name: KATHY LEE THOMAS
Title or Position: SOLE OWNER
Credential: PH.D.
Phone: 480-497-6447