Provider Demographics
NPI:1740837780
Name:THOMAS, ALETHEA JEAN (LPC)
Entity type:Individual
Prefix:
First Name:ALETHEA
Middle Name:JEAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 N 51ST ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-1649
Mailing Address - Country:US
Mailing Address - Phone:254-315-9692
Mailing Address - Fax:
Practice Address - Street 1:6501 SANGER AVE STE 302
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7802
Practice Address - Country:US
Practice Address - Phone:254-772-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70790101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
14414303OtherCAQH