Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 8395 | NE |
N | 101YS0200X | School Counselor | 2006004717 | NE |
NPI | 1225229933 |
---|---|
Provider Name | Mr. Susan Jeanette Thomas |
First Address | Fairbury, NE 68352-2318 |
Second Address | Fairbury, NE 68352-2318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 07/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8395 | DEPT OF HHS-LICENSURE (01) | NE |