Provider Demographics
NPI:1699864017
Name:THOMAS, BETTY J (CADC)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 S 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60155-3805
Mailing Address - Country:US
Mailing Address - Phone:708-202-3652
Mailing Address - Fax:708-202-7013
Practice Address - Street 1:2332 S 22ND AVE
Practice Address - Street 2:
Practice Address - City:BROADVIEW
Practice Address - State:IL
Practice Address - Zip Code:60155-3805
Practice Address - Country:US
Practice Address - Phone:708-202-3652
Practice Address - Fax:708-202-7013
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6068101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)