Provider Demographics
NPI:1437723707
Name:THOMAS, BRANDON (MA, PLPC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 MELVILLE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4512
Mailing Address - Country:US
Mailing Address - Phone:314-762-6363
Mailing Address - Fax:
Practice Address - Street 1:569 MELVILLE AVE STE 202
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-4512
Practice Address - Country:US
Practice Address - Phone:314-762-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1566009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1566009Medicaid