Provider Demographics
NPI:1750815478
Name:THOMAS, REBECCA (NA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-7825
Mailing Address - Country:US
Mailing Address - Phone:888-417-5250
Mailing Address - Fax:225-341-8756
Practice Address - Street 1:302 RICHMOND ST STE A
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3942
Practice Address - Country:US
Practice Address - Phone:985-732-2089
Practice Address - Fax:985-732-2078
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator