Individual provider Active NPI

Ty'Teana Thomas

  • Intellectual & Developmental Disabilities Psychologist
  • Flint, MI
National Provider Identifier
1053864942
Registry record updated Jul 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X
Practice address
1110 Eldon Baker Dr
Flint, MI 48507-1923
Phone
(810) 743-3134
NPI assigned
Jul 27, 2016
Last updated
Jul 27, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual & Developmental Disabilities Psychologist 103TM1800X Primary

Addresses

Primary practice location

1110 Eldon Baker Dr
Flint, MI 48507-1923

Mailing address

1110 Eldon Baker Dr
Flint, MI 48507-1923
Phone (810) 743-3134

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469577600000",
    "number": "1053864942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 ELDON BAKER DR",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485071923",
            "telephone_number": "810-743-3134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 ELDON BAKER DR",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485071923",
            "telephone_number": "810-743-3134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "TY'TEANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-27",
        "last_updated": "2016-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.