MEDICARE: SHELLIE THOMAS LMSW

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	104100000X	Social Worker	54736	TX

General Provider Information

NPI Number	:	1811277726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLIE THOMAS LMSW

Provider Business Mailing Address
First Line	:	PO BOX 6141
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 KATHRYN LN
Second Line	:	# 1328
City	:	PLANO
State	:	TX
Zip	:	75025-5249
Country	:	US
Telephone Number	:	972-359-0693
Fax Number	:	972-546-0551

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

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	08/23/2011

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