Basic Information
| Provider Information | |||||||||
| NPI: | 1881725174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8080 HARBOR CREEK DR | ||||||||
| Address2: | UNIT 101 | ||||||||
| City: | MENTOR ON THE LAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440602069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402090964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8445 MUNSON RD | ||||||||
| Address2: | |||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440602410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402551700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E0004080 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.