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General NPI Number Information
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NPI Number | 1952634552
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Entity Type | Individual
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Provider Name | ELIZABETH THOMAS LPC,LCDC
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Gender | Female
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 3851 ROGER BROOKE DRIVE BAMC - MCHE-QD(CREDS)
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-6200
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Country | US
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Telephone | 210-916-2460
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Fax |
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Provider Business Mailing Address
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Address Line | 7815 BANTRY CT VILLAS AT NORTH GATE
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City | SAN ANTONIO
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State | TX
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Zip | 78240-5722
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Country | US
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Telephone | 210-694-5252
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10314
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 62234
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License Number State | TX
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