1215901210 NPI number — BRIDGET NICHOLE THOMAS MA LPC

Table of content: BRIDGET NICHOLE THOMAS MA LPC (NPI 1215901210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215901210 NPI number — BRIDGET NICHOLE THOMAS MA LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
BRIDGET
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAFFLEUR
Provider Other First Name:
BRIDGET
Provider Other Middle Name:
NICHOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215901210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 FOUR SEASONS CENTER
Provider Second Line Business Mailing Address:
SUITE 103B
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-392-9556
Provider Business Mailing Address Fax Number:
314-392-9558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 FOUR SEASONS CENTER
Provider Second Line Business Practice Location Address:
SUITE 103B
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-392-9556
Provider Business Practice Location Address Fax Number:
314-392-9558
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  2000170546 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 494787112 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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