Provider Demographics
NPI:1598387714
Name:THOMAS, KIRSTIE (MED, PCLC,)
Entity Type:Individual
Prefix:
First Name:KIRSTIE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MED, PCLC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 MAIN ST STE 18
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3359
Mailing Address - Country:US
Mailing Address - Phone:406-697-2530
Mailing Address - Fax:
Practice Address - Street 1:3610 BARRY DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-4728
Practice Address - Country:US
Practice Address - Phone:406-697-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-31470101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional