Provider Demographics
NPI:1780157347
Name:THOMAS, WILLIAM
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30835 W 10 MILE RD # 1013
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2607
Mailing Address - Country:US
Mailing Address - Phone:734-686-1730
Mailing Address - Fax:800-519-5953
Practice Address - Street 1:30835 W 10 MILE RD # 1013
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2607
Practice Address - Country:US
Practice Address - Phone:734-686-1730
Practice Address - Fax:800-519-5953
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 102X00000X, 1041S0200X, 1744R1102X, 1744R1103X, 174H00000X, 225800000X, 226300000X
MI103K00000X, 1041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1744R1102XOther Service ProvidersSpecialistResearch Study
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
No174H00000XOther Service ProvidersHealth Educator
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist