1861764342 NPI number — MRS. TIFFANY NICOLE THOMAS MA, LPC

Table of content: MRS. TIFFANY NICOLE THOMAS MA, LPC (NPI 1861764342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861764342 NPI number — MRS. TIFFANY NICOLE THOMAS MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
TIFFANY
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861764342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 WINSTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-524-3895
Provider Business Mailing Address Fax Number:
636-931-1961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 NORTH TRUMAN BLVD
Provider Second Line Business Practice Location Address:
UPPER LEVEL J
Provider Business Practice Location Address City Name:
CRYSTAL CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-524-3895
Provider Business Practice Location Address Fax Number:
636-931-1961
Provider Enumeration Date:
01/31/2012

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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