Individual
MS. KENYATTA TANAE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
401 E. 162ND ST, SUITE 103, SOUTH HOLLAND, IL 60473
(773) 819-5504
Mailing address
2211 STOREY CT, LEXINGTON, KY 40515-1903
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
IL
251B00000X
Case Management Agency
Primary
—
KY
Other
Enumeration date
08/19/2019
Last updated
10/26/2021
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