Provider Demographics
NPI:1003358870
Name:THOMAS, PETER ELLIOT (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ELLIOT
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SE LUND AVE # 1046
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5555
Mailing Address - Country:US
Mailing Address - Phone:206-504-3203
Mailing Address - Fax:
Practice Address - Street 1:5319 BETHEL RD SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-7827
Practice Address - Country:US
Practice Address - Phone:206-504-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60694238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health