Provider Demographics
NPI:1083244156
Name:THOMAS, COREY AARON
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:AARON
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5827 COPPER BEECH BLVD APT F
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5747
Mailing Address - Country:US
Mailing Address - Phone:269-532-2562
Mailing Address - Fax:
Practice Address - Street 1:5827 COPPER BEECH BLVD APT F
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5747
Practice Address - Country:US
Practice Address - Phone:269-532-2562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician