Doctor Name: | STACIE L. THOMA |
NPI Number: | 1073680518 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LPC |
License Number: | LPC-969 |
Business Practice Address: | 1841 Madora Ave Douglas, WY - 826333057 |
Business Phone Number: | 3073582846 |
Business Fax Number: | 3083585329 |
Mailing Address: | 1841 Madora Ave, DOUGLAS |
State: | WY |
Postal Code: | 826333057 |
Phone Number: | 3073582846 |
Fax Number: | 3083585329 |
NPI Enumeration Date: | 11/29/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC-969 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |