MEDICARE: BRIDGET MICHELLE THOMAS MA, LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	9100	TX

General Provider Information

NPI Number	:	1851680987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET MICHELLE THOMAS MA, LCDC

Provider Business Mailing Address
First Line	:	14100 SOUTHWEST FWY
Second Line	:	SUITE 240
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3466
Country	:	US
Telephone Number	:	281-832-2420
Fax Number	:	281-491-3565

Provider Business Practice Location Address
First Line	:	14100 SOUTHWEST FWY
Second Line	:	SUITE 240
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3466
Country	:	US
Telephone Number	:	281-832-2420
Fax Number	:	281-491-3565

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

Provider Enumeration Date	:	03/29/2011
Last Update Date	:	03/29/2011

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