Provider Demographics
NPI:1528371796
Name:THOMAS, TERRY L (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:LAINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:71 ROAD 49031
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NM
Mailing Address - Zip Code:87413-9663
Mailing Address - Country:US
Mailing Address - Phone:970-430-8170
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:71 ROAD 49031
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NM
Practice Address - Zip Code:87413-9663
Practice Address - Country:US
Practice Address - Phone:970-430-8170
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7685493-3502101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor