Provider Demographics
NPI:1114431947
Name:SOWERS, THOMAS J (LMSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:SOWERS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BOYDSTUN LN
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-3402
Mailing Address - Country:US
Mailing Address - Phone:719-291-6401
Mailing Address - Fax:
Practice Address - Street 1:125 COMMERCE ST STE B
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-5192
Practice Address - Country:US
Practice Address - Phone:208-634-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-37153104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker