Healthcare Provider Details

I. General information

NPI: 1861376931
Provider Name (Legal Business Name): THOMAS FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2025
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 LOUELLA ST
BLACKFOOT ID
83221-1609
US

IV. Provider business mailing address

488 W 200 N
BLACKFOOT ID
83221-5405
US

V. Phone/Fax

Practice location:
  • Phone: 208-317-6318
  • Fax:
Mailing address:
  • Phone: 208-317-6318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TIA THOMAS
Title or Position: PROVIDER
Credential: LCSW
Phone: 208-317-6318