Provider Demographics
NPI:1598184129
Name:THOMAS, ATHENA MOSS
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:MOSS
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 1:2007 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2537
Mailing Address - Country:US
Mailing Address - Phone:832-532-9209
Mailing Address - Fax:281-719-9381
Practice Address - Street 1:2007 AVENUE G
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2537
Practice Address - Country:US
Practice Address - Phone:832-532-9209
Practice Address - Fax:281-719-9381
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator