Provider Demographics
NPI:1487826210
Name:THOMAS, COLLEEN MAIRE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MAIRE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-2925
Mailing Address - Country:US
Mailing Address - Phone:337-281-3608
Mailing Address - Fax:337-993-1661
Practice Address - Street 1:315 S COLLEGE RD
Practice Address - Street 2:SUITE 251
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3212
Practice Address - Country:US
Practice Address - Phone:337-654-9037
Practice Address - Fax:337-993-1661
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health