Provider Demographics
NPI:1073532685
Name:THOMAS, CARRIE CHRISTINE (PHD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:CHRISTINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16607 BLANCO RD STE 1002
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1964
Mailing Address - Country:US
Mailing Address - Phone:210-861-3900
Mailing Address - Fax:210-582-6463
Practice Address - Street 1:16607 BLANCO RD STE 1002
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1964
Practice Address - Country:US
Practice Address - Phone:210-861-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32528103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX648307OtherMEDICARE
TX1738718-01Medicaid
TX8D5701Medicare ID - Type Unspecified