Healthcare Provider Details

I. General information

NPI: 1225229933
Provider Name (Legal Business Name): SUSAN JEANETTE THOMAS M.A., PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 D ST STE. 2
FAIRBURY NE
68352-2318
US

IV. Provider business mailing address

510 D ST STE. 2
FAIRBURY NE
68352-2318
US

V. Phone/Fax

Practice location:
  • Phone: 402-729-6379
  • Fax: 402-729-4094
Mailing address:
  • Phone: 402-729-6379
  • Fax: 402-729-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8395
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number2006004717
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: