Provider Demographics
NPI:1629170972
Name:THOMAS, SHANTEL I (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHANTEL
Middle Name:I
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E GALBRAITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45216-1353
Mailing Address - Country:US
Mailing Address - Phone:513-948-0023
Mailing Address - Fax:513-948-0087
Practice Address - Street 1:203 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-1353
Practice Address - Country:US
Practice Address - Phone:513-948-0023
Practice Address - Fax:513-948-0087
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health