Provider Demographics
NPI:1013274018
Name:THOMASON, DEREK SAMUEL (LPC)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:SAMUEL
Last Name:THOMASON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 VINEYARD BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3830
Mailing Address - Country:US
Mailing Address - Phone:501-551-1943
Mailing Address - Fax:405-242-5345
Practice Address - Street 1:10400 VINEYARD BLVD STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3830
Practice Address - Country:US
Practice Address - Phone:501-551-1943
Practice Address - Fax:405-242-5345
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6461101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP1412112OtherLPC
OK6461OtherLPC
ARM1412012OtherLMFT
ARM1412012OtherLMFT