Provider Demographics
NPI:1306395207
Name:THOMAS PSYCHOLOGICAL
Entity Type:Organization
Organization Name:THOMAS PSYCHOLOGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-217-5769
Mailing Address - Street 1:27375 BLOOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3341
Mailing Address - Country:US
Mailing Address - Phone:248-217-5769
Mailing Address - Fax:
Practice Address - Street 1:27375 BLOOMFIELD DR
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-3341
Practice Address - Country:US
Practice Address - Phone:248-217-5769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty