Basic Information
| Provider Information | |||||||||
| NPI: | 1316921950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 NORTH 7TH ST | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172731710 | ||||||||
| FaxNumber: | 7172731416 | ||||||||
| Practice Location | |||||||||
| Address1: | 408 N 15TH AVE | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172749682 | ||||||||
| FaxNumber: | 7172749549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 07/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CO3404 | CO | N | Behavioral Health & Social Service Providers | Counselor | 101Y00000X | 003503PA | PA | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | C03404 | CO | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 003503PA | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 103425680 | 05 | PA | MEDICAID |