Provider Demographics
NPI:1740781228
Name:THOMAS, LAVIVIAN MICHELLE
Entity Type:Individual
Prefix:
First Name:LAVIVIAN
Middle Name:MICHELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAVIVIAN
Other - Middle Name:MICHELLE
Other - Last Name:PRICE-THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MICHELLE THOMAS
Mailing Address - Street 1:8105 RASOR BLVD STE 268
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-0104
Mailing Address - Country:US
Mailing Address - Phone:817-381-5597
Mailing Address - Fax:
Practice Address - Street 1:8105 RASOR BLVD STE 268
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-0104
Practice Address - Country:US
Practice Address - Phone:817-381-5597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty