MEDICARE: MS. KRISTA DELISE THOMAS LCPC

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
2	101YP2500X	Professional Counselor	180017773	IL
3	101YP2500X	Professional Counselor	178.019739	IL

General Provider Information

NPI Number	:	1891426375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTA DELISE THOMAS LCPC

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1457 N HALSTED ST UNIT B303
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-2677
Country	:	US
Telephone Number	:	630-428-7890
Fax Number	:	630-428-7891

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

Provider Enumeration Date	:	06/23/2022
Last Update Date	:	01/14/2026

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