Provider Demographics
NPI:1154737872
Name:CRYSTAL THOMAS, LLMSW
Entity type:Organization
Organization Name:CRYSTAL THOMAS, LLMSW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-735-0144
Mailing Address - Street 1:821 S ELMWOOD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2191
Mailing Address - Country:US
Mailing Address - Phone:231-735-0144
Mailing Address - Fax:231-947-2444
Practice Address - Street 1:821 S ELMWOOD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2191
Practice Address - Country:US
Practice Address - Phone:231-735-0144
Practice Address - Fax:231-947-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010934861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty