Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301003342 | MI |
Y | 103G00000X | Clinical Psychologist | 6301003342 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301003342 | MI |
N | 103TE1100X | Exercise & Sports Psychologist | 6301003342 | MI |
N | 103TH0100X | Health Service | 6301003342 | MI |
N | 103TP2701X | Group Psychotherapist | 6301003342 | MI |
N | 103TR0400X | Rehabilitation Psychologist | 6301003342 | MI |
NPI | 1730233313 |
---|---|
Provider Name | Dr. Paula Jean Thomas |
First Address | Southfield, MI 48075-4403 |
Second Address | Southfield, MI 48075-4403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 14/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
037366 | VALUE OPTIONS PROVIDER ID (01) | MI |
OF32385 | BCBS PROVIDER ID# (01) | MI |
R83826 | (02) | MI |