Healthcare Provider Details

I. General information

NPI: 1730233313
Provider Name (Legal Business Name): PAULA JEAN THOMAS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17515 W 9 MILE RD SUITE 975
SOUTHFIELD MI
48075-4403
US

IV. Provider business mailing address

17515 W 9 MILE RD SUITE 975
SOUTHFIELD MI
48075-4403
US

V. Phone/Fax

Practice location:
  • Phone: 248-557-3030
  • Fax: 248-557-4214
Mailing address:
  • Phone: 248-557-3030
  • Fax: 248-557-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301003342
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301003342
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number6301003342
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number6301003342
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number6301003342
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number6301003342
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: