MEDICARE: TAKIYAH THOMAS

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	6401017922	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6401017922	OTHER	MI	LICENSE NUMBER

General Provider Information

NPI Number	:	1629601919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAKIYAH THOMAS

Provider Business Mailing Address
First Line	:	6952 CALICO HORIZON ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1692
Country	:	US
Telephone Number	:	313-703-3727
Fax Number	:

Provider Business Practice Location Address
First Line	:	6952 CALICO HORIZON ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1692
Country	:	US
Telephone Number	:	313-703-3727
Fax Number	:

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

Provider Enumeration Date	:	02/15/2020
Last Update Date	:	03/20/2026

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Directions to “ TAKIYAH THOMAS ” Practice Location

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