Provider Demographics
NPI:1821212051
Name:THOMAS, TOM ABRAHAM (LCSW)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:ABRAHAM
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3538
Mailing Address - Country:US
Mailing Address - Phone:702-737-5048
Mailing Address - Fax:702-737-4752
Practice Address - Street 1:1905 COCHRAN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3538
Practice Address - Country:US
Practice Address - Phone:702-737-5048
Practice Address - Fax:702-737-4752
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00256-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical