MEDICARE: MRS. COLLEEN MAIRE 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	2615	LA

General Provider Information

NPI Number	:	1487826210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COLLEEN MAIRE THOMAS LPC

Provider Business Mailing Address
First Line	:	909 OMEGA DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-2925
Country	:	US
Telephone Number	:	337-281-3608
Fax Number	:	337-993-1661

Provider Business Practice Location Address
First Line	:	315 S COLLEGE RD
Second Line	:	SUITE 251
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3212
Country	:	US
Telephone Number	:	337-654-9037
Fax Number	:	337-993-1661

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

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	04/01/2008

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