Individual
MARY MICHELE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1011 LEHMAN AVE, SUITE 104, BOWLING GREEN, KY 42103-6515
(270) 843-8233
(270) 393-9835
Mailing address
1011 LEHMAN AVE, SUITE 104, BOWLING GREEN, KY 42103-6515
(270) 843-8233
(270) 393-9835
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSYCHOLOGIST 1311
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000358793
ANTHEM BC BLUE SHIELD
KY
Enumeration date
03/15/2007
Last updated
07/08/2007
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