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NPI Code Detail

MEDICARE: LISA V THOMAS

MEDICARE: LISA V THOMAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1063999241
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA V THOMAS
Provider Business Mailing Address
First Line : 12 W HARRISON ST
Second Line :
City : SULLIVAN
State : IL
Zip : 61951-1907
Country : US
Telephone Number : 217-728-4358
Fax Number :
Provider Business Practice Location Address
First Line : 12 W HARRISON ST
Second Line :
City : SULLIVAN
State : IL
Zip : 61951-1907
Country : US
Telephone Number : 217-728-4358
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2018
Last Update Date : 07/20/2018

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Directions to “ LISA V THOMAS ” Practice Location

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