Provider Demographics
NPI:1356327084
Name:THOMAS, DOUGLAS PAUL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:DOUG
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:100 S 1000 W
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-4010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 S 1000 W
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-4010
Practice Address - Country:US
Practice Address - Phone:435-843-3520
Practice Address - Fax:435-843-3555
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT292975-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
751648OtherDESERET MUTUAL
94293848015OtherCHAMPUS
107012410101OtherINTERMOUNTAIN HEALTH CARE
29297535000001OtherBLUE CROSS
29297535000001OtherBLUE CROSS