Provider Demographics
NPI:1558932228
Name:THOMAS, PATRICK (LMSW)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 W VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-5100
Mailing Address - Country:US
Mailing Address - Phone:602-918-4778
Mailing Address - Fax:
Practice Address - Street 1:5025 S ASH AVE STE 12
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6885
Practice Address - Country:US
Practice Address - Phone:665-792-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARLMSW-170701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ15183399OtherCAQH