Provider Demographics
NPI:1629308614
Name:KATHY THOMAS, PH.D., P.L.L.C.
Entity Type:Organization
Organization Name:KATHY THOMAS, PH.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-497-6447
Mailing Address - Street 1:33 N LINDSAY RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5807
Mailing Address - Country:US
Mailing Address - Phone:480-497-6447
Mailing Address - Fax:480-497-4166
Practice Address - Street 1:33 N LINDSAY RD
Practice Address - Street 2:SUITE 111
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5807
Practice Address - Country:US
Practice Address - Phone:480-497-6447
Practice Address - Fax:480-497-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3634103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty