Provider Demographics
NPI:1851701825
Name:THOMAS, KIMBERLY
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
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 1:1701 S 1ST AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-2419
Mailing Address - Country:US
Mailing Address - Phone:708-483-8455
Mailing Address - Fax:708-776-4717
Practice Address - Street 1:1701 S 1ST AVE STE 307
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-2419
Practice Address - Country:US
Practice Address - Phone:708-483-8455
Practice Address - Fax:708-776-4717
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008774101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional