Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801091528 | MI |
NPI | 1003180720 |
---|---|
Provider Name | Mr. Gary Lynn Thomas |
First Address | Milford, MI 48381-1691 |
Second Address | Milford, MI 48381-5107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2012 |
Last Update Date | 09/03/2016 |