MEDICARE: TESS E THOMAS PHD

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	103TC0700X	Clinical Psychologist	272366	KY
2	103TC0700X	Clinical Psychologist	285437	KY

General Provider Information

NPI Number	:	1922710037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESS E THOMAS PHD

Provider Business Mailing Address
First Line	:	740 S LIMESTONE STE K201
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0001
Country	:	US
Telephone Number	:	859-218-2509
Fax Number	:	859-323-3499

Provider Business Practice Location Address
First Line	:	740 S LIMESTONE STE K201
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-3215
Country	:	US
Telephone Number	:	859-218-2509
Fax Number	:	859-323-3499

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

Provider Enumeration Date	:	12/20/2022
Last Update Date	:	07/17/2023

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Directions to “ TESS E THOMAS PHD” Practice Location

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