MEDICARE: MR. STEPHEN CHRISTOPHER 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	101YM0800X	Mental Health Counselor	C1400615	OH

General Provider Information

NPI Number	:	1477020212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN CHRISTOPHER THOMAS LPC

Provider Business Mailing Address
First Line	:	1066 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2250
Country	:	US
Telephone Number	:	419-526-5523
Fax Number	:	419-526-5525

Provider Business Practice Location Address
First Line	:	1066 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2250
Country	:	US
Telephone Number	:	419-526-5523
Fax Number	:	419-526-5525

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

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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