Healthcare Provider Details

I. General information

NPI: 1457828451
Provider Name (Legal Business Name): KAITLIN THOMAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2018
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 S DIAMOND ST
NAMPA ID
83686-5960
US

IV. Provider business mailing address

965 RIDGE RD
MCCALL ID
83638-5417
US

V. Phone/Fax

Practice location:
  • Phone: 208-812-4999
  • Fax:
Mailing address:
  • Phone: 208-630-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-36235
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-41465
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: