Healthcare Provider Details

I. General information

NPI: 1013973999
Provider Name (Legal Business Name): THOMAS MONROE MAAS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 MONROE ST
SALMON ID
83467-3316
US

IV. Provider business mailing address

307 S TERRACE ST
SALMON ID
83467-4142
US

V. Phone/Fax

Practice location:
  • Phone: 208-589-7462
  • Fax:
Mailing address:
  • Phone: 208-589-7462
  • Fax: 208-524-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT2997
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: