Provider Demographics
NPI:1790542272
Name:THOMAS, AMY BETH
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10137 CHENEVERT RD
Mailing Address - Street 2:
Mailing Address - City:WESTWEGO
Mailing Address - State:LA
Mailing Address - Zip Code:70094-2058
Mailing Address - Country:US
Mailing Address - Phone:150-471-7955
Mailing Address - Fax:
Practice Address - Street 1:1500 LAFAYETTE ST STE 118
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5732
Practice Address - Country:US
Practice Address - Phone:504-276-5268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program