Provider Demographics
NPI:1063518637
Name:THOMAS, GARRY SCOTT (PHD, LISW, LADAC)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:SCOTT
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHD, LISW, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 SAMUEL ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-2458
Mailing Address - Country:US
Mailing Address - Phone:505-986-6181
Mailing Address - Fax:
Practice Address - Street 1:945 SAMUEL ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-2458
Practice Address - Country:US
Practice Address - Phone:505-986-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM 4015101YA0400X
KY2526361041C0700X
NMI-045561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM273042 UBSOtherUNITED BEHAVIORAL HEALTH
NM00JL16OtherBLUE CROSS BLUE SHIELD NM
NM95266OtherLOVELACE HEALTH PLAN
NMNM101176 VNM00095OtherVALUE OPTIONS
NM201047679OtherPRESBYTERIAN INSURANCE
NM273042 UBSOtherUNITED BEHAVIORAL HEALTH