MEDICARE: MRS. JENNIFER ANN THOMAS MS, LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2494	MN
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		MN

General Provider Information

NPI Number	:	1184247744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ANN THOMAS MS, LPCC

Provider Business Mailing Address
First Line	:	PO BOX 141
Second Line	:
City	:	MERRIFIELD
State	:	MN
Zip	:	56465-0141
Country	:	US
Telephone Number	:	218-514-7062
Fax Number	:	218-217-4071

Provider Business Practice Location Address
First Line	:	18510 STATE HIGHWAY 371 STE B
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-6996
Country	:	US
Telephone Number	:	218-514-7062
Fax Number	:	218-217-4071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2020
Last Update Date	:	01/03/2026

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