Provider Demographics
NPI:1265520514
Name:THOMAS, KATHARINE J (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:JO
Other - Last Name:CHRISTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6010 WEST AMARILLO BLVD
Mailing Address - Street 2:VA HEALTH SYSTEM, MENTAL HEALTH SERVICES
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109
Mailing Address - Country:US
Mailing Address - Phone:806-355-9703
Mailing Address - Fax:806-356-3794
Practice Address - Street 1:6010 W AMARILLO BLVD
Practice Address - Street 2:VA HEALTH SYSTEM, MENTAL HEALTH SERVICES
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1990
Practice Address - Country:US
Practice Address - Phone:806-355-9703
Practice Address - Fax:806-356-3794
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801072239104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN