Doctor Name: | BRENDA THOMAS |
NPI Number: | 1225407224 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LADC |
License Number: | 301064 |
Business Practice Address: | 2337 Delong Rd Osceola, WI - 540207300 |
Business Phone Number: | 7155295292 |
Business Fax Number: | 6514012822 |
Mailing Address: | 2337 Delong Rd, OSCEOLA |
State: | WI |
Postal Code: | 540207300 |
Phone Number: | 7155295292 |
Fax Number: | 6514012822 |
NPI Enumeration Date: | 09/19/2015 |
NPI Last Update Date: | 09/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 301064 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |