Provider Demographics
NPI:1922076678
Name:THOMAS, REBECCA ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 A AVE. E.
Mailing Address - Street 2:THE WESTOVER CENTER
Mailing Address - City:ALBIA
Mailing Address - State:IA
Mailing Address - Zip Code:52531
Mailing Address - Country:US
Mailing Address - Phone:641-932-0111
Mailing Address - Fax:641-932-0085
Practice Address - Street 1:202 A AVE. E.
Practice Address - Street 2:THE WESTOVER CENTER
Practice Address - City:ALBIA
Practice Address - State:IA
Practice Address - Zip Code:52531
Practice Address - Country:US
Practice Address - Phone:641-932-0111
Practice Address - Fax:641-932-0085
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003371103TC0700X
IA001135103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010196621Medicaid
VA010196621Medicaid