Provider Demographics
NPI:1194022483
Name:THOMAS, AMBER LUCILLE (LSCSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LUCILLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-3446
Mailing Address - Country:US
Mailing Address - Phone:913-287-1300
Mailing Address - Fax:913-287-3059
Practice Address - Street 1:5424 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-3446
Practice Address - Country:US
Practice Address - Phone:913-287-1300
Practice Address - Fax:913-287-3059
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7445104100000X
KS44341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1336255173Medicaid