Provider Demographics
NPI:1427184399
Name:THOMAS, GAYLE TERESA (MSW, MHP, CPRP)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:TERESA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSW, MHP, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1403
Mailing Address - Country:US
Mailing Address - Phone:612-331-7390
Mailing Address - Fax:612-331-4436
Practice Address - Street 1:1025 6TH ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1403
Practice Address - Country:US
Practice Address - Phone:612-331-7390
Practice Address - Fax:612-331-4436
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN173213104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker