MEDICARE: MS. ERICA 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	C.2103195	OH
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1760981302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERICA THOMAS

Provider Business Mailing Address
First Line	:	5846 SCARLET OAK DR
Second Line	:
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-3048
Country	:	US
Telephone Number	:	216-906-0422
Fax Number	:

Provider Business Practice Location Address
First Line	:	5198 RICHMOND RD
Second Line	:
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-1331
Country	:	US
Telephone Number	:	216-906-0422
Fax Number	:

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

Provider Enumeration Date	:	02/09/2018
Last Update Date	:	10/08/2021

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