Provider Demographics
NPI:1659484707
Name:THOMAS, PETER (PSYD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 N MILL ST
Mailing Address - Street 2:UNIT 5
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5336
Mailing Address - Country:US
Mailing Address - Phone:815-385-6004
Mailing Address - Fax:815-385-6062
Practice Address - Street 1:814 N MILL ST
Practice Address - Street 2:UNIT 5
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5336
Practice Address - Country:US
Practice Address - Phone:815-385-6004
Practice Address - Fax:815-385-6062
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical