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General NPI Number Information
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NPI Number | 1467832907
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Entity Type | Individual
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Provider Name | AMY M THOME LCPC, PSYD
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Gender | Female
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Dates
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Enumeration Date | 05/30/2015
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 770 LAKE COOK RD SUITE 270
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City | DEERFIELD
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State | IL
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Zip | 60015-4920
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Country | US
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Telephone | 312-945-1098
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Fax | 312-275-7340
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Provider Business Mailing Address
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Address Line | 770 LAKE COOK RD SUITE 270
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City | DEERFIELD
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State | IL
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Zip | 60015-4920
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Country | US
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Telephone | 312-945-1098
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Fax | 312-275-7340
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.009720
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License Number State | IL
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