MEDICARE: MR. BRUCE ANDREW THOMAS 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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor	92532	TX
4	101YP2500X	Professional Counselor	3451	MS
5	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1407789522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE ANDREW THOMAS LPC

Provider Business Mailing Address
First Line	:	2113 W WELLSGATE DR
Second Line	:
City	:	OXFORD
State	:	MS
Zip	:	38655-6022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2113 W WELLSGATE DR
Second Line	:
City	:	OXFORD
State	:	MS
Zip	:	38655-6022
Country	:	US
Telephone Number	:	214-796-3565
Fax Number	:

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

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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