Individual
CHANTELLE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, PHD
Contact information
Practice address
702 LORILLARD CT, APT 107, MADISON, WI 53703-3897
(805) 358-9813
Mailing address
702 LORILLARD CT, #107, MADISON, WI 53703-3897
(805) 358-9813
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2878-57
WI
Other
Enumeration date
08/24/2010
Last updated
08/18/2016
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