Provider Demographics
NPI:1225274673
Name:THUES, JEROME ANTHONY SR (MALLPCEDSPEC)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:ANTHONY
Last Name:THUES
Suffix:SR
Gender:M
Credentials:MALLPCEDSPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28388 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5503
Mailing Address - Country:US
Mailing Address - Phone:313-615-6701
Mailing Address - Fax:
Practice Address - Street 1:18004 WILDEMERE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2729
Practice Address - Country:US
Practice Address - Phone:313-863-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health