Provider Demographics
NPI:1790102689
Name:THOMAS, EMMA SELIINA (PHD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:SELIINA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:SELIINA
Other - Last Name:SIPILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31075 FLORALVIEW DR S APT 207
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-5861
Mailing Address - Country:US
Mailing Address - Phone:734-771-7236
Mailing Address - Fax:
Practice Address - Street 1:6888 W MAPLE RD FL 1
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3032
Practice Address - Country:US
Practice Address - Phone:248-846-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-17-26386103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst