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NPI Code Detail

MEDICARE: CANDACE CHERILYN THOM MA, LPC

MEDICARE: CANDACE CHERILYN THOM MA, 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
1101YP2500XProfessional Counselor37PC01209000NJ

General Provider Information

NPI Number : 1689261653
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE CHERILYN THOM MA, LPC
Provider Business Mailing Address
First Line : 18436 WINSLOW RD UPPR
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-4813
Country : US
Telephone Number : 646-732-8393
Fax Number :
Provider Business Practice Location Address
First Line : 18436 WINSLOW RD UPPR
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-4813
Country : US
Telephone Number : 646-732-8393
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/24/2020
Last Update Date : 12/05/2025

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