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General NPI Number Information
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NPI Number | 1477195451
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Entity Type | Individual
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Provider Name | JACQUELINE REEVES THOMAS LPC
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Gender | Female
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Dates
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Enumeration Date | 10/11/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | MEMPHIS VETERANS AFFAIRS MEDICAL CENTER (VAMC) 1030 JEFFERSON AVE
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City | MEMPHIS
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State | TN
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Zip | 38016
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Country | US
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Telephone | 901-523-8990
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Fax |
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Provider Business Mailing Address
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Address Line | 2860 GOOSE CREEK DR APT 103
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City | CORDOVA
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State | TN
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Zip | 38016-1834
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Country | US
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Telephone | 301-613-5064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC0000004507
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License Number State | TN
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