Lia Kay Thibodaux, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

61029049 Issued in WA

Practice address

Medical Center Blvd
Winston Salem, NC 27157-3901

Phone

(336) 716-2261

Fax

(336) 716-9810

NPI assigned

Jan 15, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wake Forest University Health SciencesGroup PAC ID 4486564952, 2,633 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1003803032
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1610668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1891384681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-2261",
            "fax_number": "336-716-9810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271573901",
            "telephone_number": "336-716-2261",
            "fax_number": "336-716-9810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4800 Sand Point Way NE # Oa.5154",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981053901",
            "country_code": "US",
            "telephone_number": "206-987-1012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THIBODAUX",
        "first_name": "LIA",
        "middle_name": "KAY",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-15",
        "last_updated": "2021-11-03",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "6003",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "61029049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Wells Center Inc for Women in Transition
• Pierre-Richard Didier Theard, MD
• Mary Ann Thenganatt, M.D.
• Theodore Limerick, DDS, P.a.
• Adam Thibeault
• Eugene Henry Thiebaud, PAC
• Scott Taylor Thiesfeldt, MD
• Jacob Kly Thiessen
• Bernetta Thigpen, MS
• Thomas E Simpson Mdpa

• Psychologist in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.