Healthcare Provider Details

I. General information

NPI: 1851091003
Provider Name (Legal Business Name): JENNIFER S THOMAS MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 1ST AVE NE
OSSEO MN
55369-1201
US

IV. Provider business mailing address

225 1ST AVE NE
OSSEO MN
55369-1201
US

V. Phone/Fax

Practice location:
  • Phone: 763-230-5080
  • Fax:
Mailing address:
  • Phone: 763-230-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101007514
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717002233
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4415
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: