MEDICARE: SANDRA 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
1	103TS0200X	School Psychologist	70213	TX
2	101YP2500X	Professional Counselor	91177	TX

General Provider Information

NPI Number	:	1164237822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA THOMAS

Provider Business Mailing Address
First Line	:	3212 PEARL BLUFF LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-3347
Country	:	US
Telephone Number	:	310-266-6364
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 PEARL BLUFF LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-3347
Country	:	US
Telephone Number	:	310-266-6364
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	02/10/2025

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Directions to “ SANDRA THOMAS ” Practice Location

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