Provider Demographics
NPI:1871223107
Name:THOMAS, BENJAMIN DYLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DYLAN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2001
Mailing Address - Country:US
Mailing Address - Phone:571-201-7802
Mailing Address - Fax:
Practice Address - Street 1:111 TUMWATER BLVD SE STE C213
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6400
Practice Address - Country:US
Practice Address - Phone:360-706-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61074901103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical