Healthcare Provider Details

I. General information

NPI: 1255012977
Provider Name (Legal Business Name): JLTHOMASTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 108TH ST SE
EVERETT WA
98208-7515
US

IV. Provider business mailing address

3116 108TH ST SE
EVERETT WA
98208-7515
US

V. Phone/Fax

Practice location:
  • Phone: 443-960-0348
  • Fax:
Mailing address:
  • Phone: 443-960-0348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDITH L THOMAS
Title or Position: OWNER/MENTAL HEALTH COUNSELOR
Credential:
Phone: 443-960-0348