Provider Demographics
NPI:1144400425
Name:THOMAS, SARAH NICOLE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:NICOLE
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1416 CROWN DR
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2548
Mailing Address - Country:US
Mailing Address - Phone:660-627-5757
Mailing Address - Fax:660-627-5802
Practice Address - Street 1:1508 CROWN DR
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2553
Practice Address - Country:US
Practice Address - Phone:660-627-3621
Practice Address - Fax:660-627-5798
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050374241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497585703Medicaid
MO121650001Medicare PIN
MO000011740Medicare PIN
MO141570001Medicare PIN
MO261821Medicare Oscar/Certification
MO000012165Medicare PIN
MO000014157Medicare PIN
MO261848Medicare Oscar/Certification
MO117400002Medicare PIN
MO497585703Medicaid