Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1043357007 |
---|---|
Provider Name | Mr. Randall Kent Thomas |
First Address | Scottsdale, AZ 85257-1502 |
Second Address | Scottsdale, AZ 85257-1502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
629157 | (05) | AZ |