MEDICARE: THOMAS ASSOCIATES FOUNDATION, INC

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center	4048	MD

General Provider Information

NPI Number	:	1790938736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS ASSOCIATES FOUNDATION, INC

Provider Business Mailing Address
First Line	:	825 N HAMMONDS FERRY RD
Second Line	:	SUITE A
City	:	LINTHICUM
State	:	MD
Zip	:	21090-1355
Country	:	US
Telephone Number	:	410-789-2635
Fax Number	:	410-789-2767

Provider Business Practice Location Address
First Line	:	825 N HAMMONDS FERRY RD
Second Line	:	SUITE A
City	:	LINTHICUM
State	:	MD
Zip	:	21090-1355
Country	:	US
Telephone Number	:	410-789-2635
Fax Number	:	410-789-2767

Authorized Official
Title or Position	:	EXECUTIVE V.P.
Name	:	MR. EDWIN RICHARD BUTLER III
Credential	:
Telephone Number	:	443-661-1301

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	11/03/2008

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