Provider Demographics
NPI:1396202727
Name:THOMAS, JEROD MITCHELL (CADC)
Entity Type:Individual
Prefix:
First Name:JEROD
Middle Name:MITCHELL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 MAXWELTON CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-4012
Mailing Address - Country:US
Mailing Address - Phone:859-252-1939
Mailing Address - Fax:
Practice Address - Street 1:635 MAXWELTON CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-4012
Practice Address - Country:US
Practice Address - Phone:859-252-1939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166725101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)