Healthcare Provider Details

I. General information

NPI: 1609254093
Provider Name (Legal Business Name): CARRIE THOMAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 E ROSEBRIER ST
SPRINGFIELD MO
65804-3800
US

IV. Provider business mailing address

1948 E ROSEBRIER ST
SPRINGFIELD MO
65804-3800
US

V. Phone/Fax

Practice location:
  • Phone: 417-425-2907
  • Fax: 417-315-5393
Mailing address:
  • Phone: 417-425-2907
  • Fax: 417-315-5393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2005014860
License Number StateMO

VIII. Authorized Official

Name: CARRIE E THOMAS
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 417-425-2907