Provider Demographics
NPI:1538832753
Name:THOMAS, MARY KATHLEEN (CBHPSS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CBHPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 RIMINI CT
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7043
Mailing Address - Country:US
Mailing Address - Phone:406-239-9991
Mailing Address - Fax:
Practice Address - Street 1:202 BROOKS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4019
Practice Address - Country:US
Practice Address - Phone:406-926-1453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist