MEDICARE: DEIDRA LASHELLE THOMAS RBT

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	251S00000X	Community/Behavioral Health Agency
2	106S00000X	Behavior Technician	RBT-18-55627	NV

General Provider Information

NPI Number	:	1205171352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIDRA LASHELLE THOMAS RBT

Provider Business Mailing Address
First Line	:	3929 ROYAL STONE CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-1225
Country	:	US
Telephone Number	:	702-237-9736
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 HIGH UINTAS DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031
Country	:	US
Telephone Number	:	702-955-9351
Fax Number	:

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

Provider Enumeration Date	:	11/30/2012
Last Update Date	:	08/23/2018

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