Healthcare Provider Details

I. General information

NPI: 1629939533
Provider Name (Legal Business Name): JUSTIN RAYMOND THOMAS M.A.,LA.D.C,L.P.C.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 NININGER RD
HASTINGS MN
55033-1086
US

IV. Provider business mailing address

ALLINA HEALTH NININGER ROAD CLINIC 1285 NININGER ROAD
HASTINGS MN
55033-1086
US

V. Phone/Fax

Practice location:
  • Phone: 651-480-4200
  • Fax: 651-480-4306
Mailing address:
  • Phone: 651-404-1400
  • Fax: 651-404-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC-5018
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5018
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLADC-305434
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: