Provider Demographics
NPI:1003180720
Name:THOMAS, GARY LYNN (LMSW,ACSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LMSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1042 N MILFORD RD
Practice Address - Street 2:SUITE 205
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-5107
Practice Address - Country:US
Practice Address - Phone:284-825-9545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010915281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical