Provider Demographics
NPI:1275510273
Name:THOMAS, JANET THERESA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:THERESA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 PORTLAND AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2223
Mailing Address - Country:US
Mailing Address - Phone:651-291-2737
Mailing Address - Fax:651-291-2728
Practice Address - Street 1:614 PORTLAND AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2272
Practice Address - Country:US
Practice Address - Phone:651-291-2737
Practice Address - Fax:651-291-2728
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1864103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling