MEDICARE: KATHRYN ASHA THUMME LMFT, CST

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	106H00000X	Marriage & Family Therapist	166.000760	IL
2	106H00000X	Marriage & Family Therapist	806-124	WI

General Provider Information

NPI Number	:	1891961314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ASHA THUMME LMFT, CST

Provider Business Mailing Address
First Line	:	100 N ATKINSON RD STE 112E
Second Line	:
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-7805
Country	:	US
Telephone Number	:	847-682-0290
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N ATKINSON RD STE 112E
Second Line	:
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-7805
Country	:	US
Telephone Number	:	847-682-0290
Fax Number	:

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

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/04/2012

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