Provider Demographics
NPI:1225229933
Name:THOMAS, SUSAN JEANETTE (MA, PLMHP)
Entity Type:Individual
Prefix:MR
First Name:SUSAN
Middle Name:JEANETTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 D ST
Mailing Address - Street 2:STE. 2
Mailing Address - City:FAIRBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68352-2318
Mailing Address - Country:US
Mailing Address - Phone:402-729-6379
Mailing Address - Fax:402-729-4094
Practice Address - Street 1:510 D ST
Practice Address - Street 2:STE. 2
Practice Address - City:FAIRBURY
Practice Address - State:NE
Practice Address - Zip Code:68352-2318
Practice Address - Country:US
Practice Address - Phone:402-729-6379
Practice Address - Fax:402-729-4094
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8395101YM0800X
NE2006004717101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE8395OtherDEPT OF HHS-LICENSURE