MEDICARE: LINDA L. NACE-THOMAS MS,LSW,PC

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	101YP2500X	Professional Counselor	C.0501378	OH
2	104100000X	Social Worker	S24336	OH

General Provider Information

NPI Number	:	1366620387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA L. NACE-THOMAS MS,LSW,PC

Provider Business Mailing Address
First Line	:	77 W ELMWOOD DR
Second Line	:	SUITE 202
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4239
Country	:	US
Telephone Number	:	937-436-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 W ELMWOOD DR
Second Line	:	SUITE 202
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4239
Country	:	US
Telephone Number	:	937-436-0700
Fax Number	:	937-424-5749

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

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	08/03/2010

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