MEDICARE: ERIC THISS MA, LPC, LCMHC

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	LPC-22156	AZ

General Provider Information

NPI Number	:	1740865328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC THISS MA, LPC, LCMHC

Provider Business Mailing Address
First Line	:	16620 N 40TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3348
Country	:	US
Telephone Number	:	623-980-3005
Fax Number	:

Provider Business Practice Location Address
First Line	:	16620 N 40TH ST STE G1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032
Country	:	US
Telephone Number	:	602-363-0629
Fax Number	:

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

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	05/28/2026

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