MEDICARE: MRS. BRANDI LACHELLE THOMAS LCSW

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	1041C0700X	Clinical Social Worker	1662C	AL

General Provider Information

NPI Number	:	1285732024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDI LACHELLE THOMAS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 93055
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33804-3055
Country	:	US
Telephone Number	:	813-228-2761
Fax Number	:	813-225-7048

Provider Business Practice Location Address
First Line	:	14517 BRUCE B DOWNS BLVD STE 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-2755
Country	:	US
Telephone Number	:	813-228-2761
Fax Number	:	813-225-7048

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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