Provider Demographics
NPI:1457816746
Name:THOMAS, TELEA RENEE
Entity Type:Individual
Prefix:
First Name:TELEA
Middle Name:RENEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426925 E 1090 RD
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-5493
Mailing Address - Country:US
Mailing Address - Phone:918-843-1701
Mailing Address - Fax:918-426-5526
Practice Address - Street 1:426925 E 1090 RD
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-5493
Practice Address - Country:US
Practice Address - Phone:918-843-1701
Practice Address - Fax:918-426-5526
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty