Healthcare Provider Details

I. General information

NPI: 1952579385
Provider Name (Legal Business Name): SHEILA THOMAS, M.A.L.P., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 RAYMOND AVE SUITE 270
SAINT PAUL MN
55114-1503
US

IV. Provider business mailing address

821 RAYMOND AVE SUITE 270
SAINT PAUL MN
55114-1503
US

V. Phone/Fax

Practice location:
  • Phone: 612-710-5180
  • Fax: 651-379-0993
Mailing address:
  • Phone: 612-710-5180
  • Fax: 651-379-0993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number3025
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3025
License Number StateMN

VIII. Authorized Official

Name: SHEILA L THOMAS
Title or Position: PRESIDENT
Credential: M.A., L.P.
Phone: 612-710-5180