Provider Demographics
NPI:1700073228
Name:THOMAS, HILTON TELLIS (PHD)
Entity type:Individual
Prefix:DR
First Name:HILTON
Middle Name:TELLIS
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S WAVERLY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-3631
Mailing Address - Country:US
Mailing Address - Phone:517-321-5900
Mailing Address - Fax:517-321-5945
Practice Address - Street 1:302 S WAVERLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-3631
Practice Address - Country:US
Practice Address - Phone:517-321-5900
Practice Address - Fax:517-321-5945
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003971103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C34604Medicare PIN