Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 12732 | FL |
Y | 101YM0800X | Mental Health Counselor | 12732 | FL |
NPI | 1003223082 |
---|---|
Provider Name | Jane Thomas |
First Address | Pensacola, FL 32503-4008 |
Second Address | Pensacola, FL 32503-4008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2014 |
Last Update Date | 22/07/2014 |