Healthcare Provider Details

I. General information

NPI: 1184247744
Provider Name (Legal Business Name): JENNIFER ANN THOMAS MS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER ANN THOMAS MS, LPCC

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18510 STATE HIGHWAY 371 STE B
BRAINERD MN
56401-6996
US

IV. Provider business mailing address

PO BOX 141
MERRIFIELD MN
56465-0141
US

V. Phone/Fax

Practice location:
  • Phone: 218-514-7062
  • Fax: 218-217-4071
Mailing address:
  • Phone: 218-514-7062
  • Fax: 218-217-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2494
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: