Provider Demographics
NPI:1568195766
Name:THOMAS, KAREN ELAINE (PPSC, CSP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELAINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PPSC, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 BELLA VERDE TER APT 231
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9679
Mailing Address - Country:US
Mailing Address - Phone:408-201-4796
Mailing Address - Fax:
Practice Address - Street 1:825 BELLA VERDE TER APT 231
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9679
Practice Address - Country:US
Practice Address - Phone:408-201-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool