Provider Demographics
NPI:1366037384
Name:THOMAS, JILL M (LCSW, MMHC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW, MMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CURTIS XRDS
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-5403
Mailing Address - Country:US
Mailing Address - Phone:208-420-4946
Mailing Address - Fax:
Practice Address - Street 1:203 CURTIS XRDS
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-5403
Practice Address - Country:US
Practice Address - Phone:208-420-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN75361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical