Provider Demographics
NPI:1568608099
Name:THOMAS, LISA MAE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MAE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 N POPLAR ST STE 183
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1304
Mailing Address - Country:US
Mailing Address - Phone:307-472-9890
Mailing Address - Fax:307-472-9891
Practice Address - Street 1:907 N POPLAR ST STE 183
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1304
Practice Address - Country:US
Practice Address - Phone:307-472-9890
Practice Address - Fax:307-472-9891
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW304101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYLCSW-703OtherSTATE LICENSE