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General NPI Number Information
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NPI Number | 1548394943
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Entity Type | Organization
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Legal Business Name | ANAM CARA, LLC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1011 LEHMAN AVE SUITE 104
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City | BOWLING GREEN
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State | KY
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Zip | 42103-6515
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Country | US
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Telephone | 270-843-8233
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Fax | 270-393-9835
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Provider Business Mailing Address
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Address Line | 1011 LEHMAN AVE SUITE 104
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City | BOWLING GREEN
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State | KY
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Zip | 42103-6515
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Country | US
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Telephone | 270-843-8233
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Fax | 270-393-9835
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | MARY MICHELE THOMAS
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Credential | PH.D.
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Telephone | 270-843-8233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSYCHOLOGIST 1311
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License Number State | KY
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