Provider Demographics
NPI:1083815625
Name:THOMAS, MILA (CIT)
Entity Type:Individual
Prefix:MISS
First Name:MILA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6717 SANDPIPER CIR
Mailing Address - Street 2:
Mailing Address - City:IOWA
Mailing Address - State:LA
Mailing Address - Zip Code:70647-3828
Mailing Address - Country:US
Mailing Address - Phone:337-433-2843
Mailing Address - Fax:
Practice Address - Street 1:3505 5TH AVE STE B
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-2156
Practice Address - Country:US
Practice Address - Phone:337-475-4855
Practice Address - Fax:337-475-4858
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CV41Medicare ID - Type Unspecified