Provider Demographics
NPI:1336658996
Name:THOMAS, EBONY MICHELLE (BHWC)
Entity Type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:MICHELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17005 PRESTWICK CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7405
Mailing Address - Country:US
Mailing Address - Phone:405-425-0486
Mailing Address - Fax:405-419-3007
Practice Address - Street 1:4300 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5107
Practice Address - Country:US
Practice Address - Phone:405-425-0486
Practice Address - Fax:405-419-3007
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health