Provider Demographics
NPI:1669592275
Name:THOMAS, EDWARD MADOC (PHD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MADOC
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 1:4630 50TH ST
Mailing Address - Street 2:SUITE 412
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-3521
Mailing Address - Country:US
Mailing Address - Phone:806-794-3232
Mailing Address - Fax:
Practice Address - Street 1:4630 50TH ST
Practice Address - Street 2:SUITE 412
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3521
Practice Address - Country:US
Practice Address - Phone:806-794-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1916106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8122BHOtherBLUE CROSS BLUE SHIELD