Provider Demographics
NPI:1760978043
Name:THOMAS TRAUMATOLOGY INSTITUTE
Entity Type:Organization
Organization Name:THOMAS TRAUMATOLOGY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAKPANGI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC, CT, AC
Authorized Official - Phone:313-312-0087
Mailing Address - Street 1:11825 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1007
Mailing Address - Country:US
Mailing Address - Phone:313-312-0087
Mailing Address - Fax:313-447-2277
Practice Address - Street 1:11825 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1007
Practice Address - Country:US
Practice Address - Phone:313-312-0087
Practice Address - Fax:313-447-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012784101YP2500X, 251300000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)