Provider Demographics
NPI:1326591116
Name:BRINKLEY, THOMAS (LMSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:BRINKLEY
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 1:1259 N 1120 E
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-5170
Mailing Address - Country:US
Mailing Address - Phone:208-200-9545
Mailing Address - Fax:
Practice Address - Street 1:2647 E 14 N
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83401-2301
Practice Address - Country:US
Practice Address - Phone:208-552-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID35997101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor