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NPI Code Detail

MEDICARE: ZACHARY ETHAN THOMAS

MEDICARE:   ZACHARY ETHAN 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 Counselor8133-226WI

General Provider Information

NPI Number : 1114744133
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACHARY ETHAN THOMAS
Provider Business Mailing Address
First Line : 2323 N LAKE DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53211-4508
Country : US
Telephone Number : 850-803-9126
Fax Number :
Provider Business Practice Location Address
First Line : 2323 N LAKE DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53211-4508
Country : US
Telephone Number : 850-803-9126
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2024
Last Update Date : 06/09/2026

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Directions to “ ZACHARY ETHAN THOMAS ” Practice Location

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