Provider Demographics
NPI:1649383613
Name:PETER THOMAS PHD PERSONAL COPORATION
Entity Type:Organization
Organization Name:PETER THOMAS PHD PERSONAL COPORATION
Other - Org Name:PETER THOMAS, PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-356-8724
Mailing Address - Street 1:19018 CORLISS AVE N STE 300
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4146
Mailing Address - Country:US
Mailing Address - Phone:206-356-8724
Mailing Address - Fax:206-417-2841
Practice Address - Street 1:19018 CORLISS AVE N STE 300
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4146
Practice Address - Country:US
Practice Address - Phone:206-356-8724
Practice Address - Fax:206-417-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1172103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8912335OtherCRIME VICTIMS COMP PROV#
WA78567OtherLABOR & INDUSTRIES PROV#
WAAETNAOther5113341
WAR11136Medicare UPIN
WATH3884OtherTRICARE PROV #
WAR11136Medicare UPIN
WA8912335OtherCRIME VICTIMS COMP PROV#
WA78567OtherLABOR & INDUSTRIES PROV#
WATH3884OtherREGENCE BLUE SHIELD PROV#