Basic Information
| Provider Information | |||||||||
| NPI: | 1750984282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | KARLEE | ||||||||
| MiddleName: | |||||||||
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| Credential: | QMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | STANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488889702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898317520 | ||||||||
| FaxNumber: | 9898317578 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | STANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488889702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165271790 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2020 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106E00000X | N | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 1715928 | 05 | MI | MEDICAID |