Provider Demographics
NPI:1750792297
Name:THOMAS, SUSANN DENISE (MED, LPA)
Entity type:Individual
Prefix:
First Name:SUSANN
Middle Name:DENISE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MED, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0320
Mailing Address - Fax:502-588-0326
Practice Address - Street 1:529 S JACKSON ST
Practice Address - Street 2:J GRAHAM BROWN CANCER CENTER, BEHAVIORAL ONCOLOGY
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3229
Practice Address - Country:US
Practice Address - Phone:502-852-7843
Practice Address - Fax:502-217-8397
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional