Provider Demographics
NPI:1356899553
Name:THOMAS, PATRICE
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FOREST DR APT 804
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-7916
Mailing Address - Country:US
Mailing Address - Phone:608-448-5795
Mailing Address - Fax:877-560-0578
Practice Address - Street 1:348 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1940
Practice Address - Country:US
Practice Address - Phone:608-477-9858
Practice Address - Fax:608-415-9956
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health