MEDICARE: BRANDON THOMA LPC

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	171M00000X	Case Manager/Care Coordinator
2	101YP2500X	Professional Counselor	2015035432	MO

General Provider Information

NPI Number	:	1336525542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON THOMA LPC

Provider Business Mailing Address
First Line	:	1834 KATIE ROSE TRL
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-2277
Country	:	US
Telephone Number	:	314-346-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1834 KATIE ROSE TRL
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-2277
Country	:	US
Telephone Number	:	314-346-3400
Fax Number	:

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

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	03/04/2021

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