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General NPI Number Information
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NPI Number | 1548593734
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Entity Type | Individual
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Provider Name | CALEX M THOMAS LCPC
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Gender | Male
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Dates
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Enumeration Date | 09/07/2009
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 3317 W 95TH ST SUITE LL2
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2243
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Country | US
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Telephone | 170-838-6078
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 42798
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-0798
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Country | US
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Telephone | 773-599-3406
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180008585
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License Number State | IL
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