1265520514 NPI number — MS. KATHARINE J THOMAS CLINICAL SOCIAL WORK

Table of content: MS. KATHARINE J THOMAS CLINICAL SOCIAL WORK (NPI 1265520514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265520514 NPI number — MS. KATHARINE J THOMAS CLINICAL SOCIAL WORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
KATHARINE
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CLINICAL SOCIAL WORK
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTY
Provider Other First Name:
KATHARINE
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265520514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6010 WEST AMARILLO BLVD
Provider Second Line Business Mailing Address:
VA HEALTH SYSTEM, MENTAL HEALTH SERVICES
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-355-9703
Provider Business Mailing Address Fax Number:
806-356-3794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6010 W AMARILLO BLVD
Provider Second Line Business Practice Location Address:
VA HEALTH SYSTEM, MENTAL HEALTH SERVICES
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-355-9703
Provider Business Practice Location Address Fax Number:
806-356-3794
Provider Enumeration Date:
10/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6801072239 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)