Provider Demographics
NPI:1245647379
Name:MARY CARMEN THOMAS LPC, PLLC
Entity type:Organization
Organization Name:MARY CARMEN THOMAS LPC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:STIVALET-THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:956-627-2487
Mailing Address - Street 1:315 W NOLANA AVE
Mailing Address - Street 2:# C
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2541
Mailing Address - Country:US
Mailing Address - Phone:956-627-2487
Mailing Address - Fax:956-627-3528
Practice Address - Street 1:315 W NOLANA AVE
Practice Address - Street 2:# C
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2541
Practice Address - Country:US
Practice Address - Phone:956-627-2487
Practice Address - Fax:956-627-3528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68345101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX315767901Medicaid