Basic Information
| Provider Information | |||||||||
| NPI: | 1619512662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | MARLISHA | ||||||||
| MiddleName: | LORRAINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5577 YARBOROUGH DR | ||||||||
| Address2: | |||||||||
| City: | FORNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751263391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624400301 | ||||||||
| FaxNumber: | 4692429833 | ||||||||
| Practice Location | |||||||||
| Address1: | 7777 FOREST LN STE C833 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752302591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725664591 | ||||||||
| FaxNumber: | 9725666679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2019 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP144002 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | AP144002 | 01 | TX | APRN | OTHER | 894032 | 01 | MS | COMPACT LICENSE(RN) | OTHER |