Provider Demographics
NPI:1790271583
Name:THOMAS, DAVID TODD (MA, LLPC, NCC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TODD
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MA, LLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 TAHOE AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-2144
Mailing Address - Country:US
Mailing Address - Phone:269-806-2862
Mailing Address - Fax:
Practice Address - Street 1:1000 W PATERSON ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-1710
Practice Address - Country:US
Practice Address - Phone:269-389-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional