Provider Demographics
NPI:1689933442
Name:THOMAS, CHERISE JOY
Entity Type:Individual
Prefix:
First Name:CHERISE
Middle Name:JOY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 BOULDER HWY
Mailing Address - Street 2:1096
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-7418
Mailing Address - Country:US
Mailing Address - Phone:310-704-7290
Mailing Address - Fax:
Practice Address - Street 1:6655 BOULDER HWY
Practice Address - Street 2:1096
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-7418
Practice Address - Country:US
Practice Address - Phone:310-704-7290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical