Provider Demographics
NPI:1114378221
Name:THOMAS, AMY LIN (MASTERS PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LIN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MASTERS PSYCHOLOGY
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LIN
Other - Last Name:BLANKENSHIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6791 WAIPOULI RD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-8840
Mailing Address - Country:US
Mailing Address - Phone:317-809-1532
Mailing Address - Fax:
Practice Address - Street 1:6791 WAIPOULI RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-8840
Practice Address - Country:US
Practice Address - Phone:317-809-1532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health