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General NPI Number Information
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NPI Number | 1023873478
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Entity Type | Individual
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Provider Name | EMILY CRADDOCK THOMAS PHD
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Gender | Female
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 930 N SWITZER CANYON DR
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-4824
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Country | US
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Telephone | 928-224-9235
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Fax |
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Provider Business Mailing Address
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Address Line | 2855 N ELK RUN ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-7609
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Country | US
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Telephone | 404-668-7221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY-005749
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License Number State | AZ
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