Provider Demographics
NPI:1710582010
Name:DR. TRE THOMAS, PSYCHOLOGIST, PLLC
Entity Type:Organization
Organization Name:DR. TRE THOMAS, PSYCHOLOGIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAJANA
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-498-9349
Mailing Address - Street 1:616 CAMELLIA AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-2438
Mailing Address - Country:US
Mailing Address - Phone:813-498-9349
Mailing Address - Fax:941-894-1312
Practice Address - Street 1:616 CAMELLIA AVE
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-2438
Practice Address - Country:US
Practice Address - Phone:813-498-9349
Practice Address - Fax:941-894-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)