Provider Demographics
NPI:1609155936
Name:THOM, BOBBIE JO
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JO
Last Name:THOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BOBBIE
Other - Middle Name:JO
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 CALDWELL DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1152
Mailing Address - Country:US
Mailing Address - Phone:814-371-1100
Mailing Address - Fax:814-375-0120
Practice Address - Street 1:793 OLD ROUTE 119 HWY N
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1372
Practice Address - Country:US
Practice Address - Phone:724-465-5576
Practice Address - Fax:724-465-6379
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor