Provider Demographics
NPI:1275064479
Name:THOMAS, KATIE LYNN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W 1ST AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-6002
Mailing Address - Country:US
Mailing Address - Phone:509-724-0647
Mailing Address - Fax:
Practice Address - Street 1:308 W 1ST AVE STE 310
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-6002
Practice Address - Country:US
Practice Address - Phone:509-724-0647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60680131101Y00000X
WALW610158701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor