Provider Demographics
NPI:1477927812
Name:THOMAS, CHRISTY JOY (MSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:JOY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-9700
Mailing Address - Country:US
Mailing Address - Phone:208-354-3005
Mailing Address - Fax:208-354-3006
Practice Address - Street 1:85 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-9700
Practice Address - Country:US
Practice Address - Phone:208-354-3005
Practice Address - Fax:208-354-3006
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-29811104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker