Provider Demographics
NPI:1184820946
Name:THOMAS, KAISHA A (PHD, LMHC, LMFT, SAP)
Entity Type:Individual
Prefix:DR
First Name:KAISHA
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHD, LMHC, LMFT, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE # 405
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2323
Mailing Address - Country:US
Mailing Address - Phone:561-288-0114
Mailing Address - Fax:
Practice Address - Street 1:1555 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE #405
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2323
Practice Address - Country:US
Practice Address - Phone:561-288-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2041106H00000X
FLMH 7384101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7670516Medicaid