Provider Demographics
NPI:1609989151
Name:THOMAS, JAYAN EDER (LCSW)
Entity Type:Individual
Prefix:
First Name:JAYAN
Middle Name:EDER
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAYAN
Other - Middle Name:SUE
Other - Last Name:EDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:914 LILY CREEK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2815
Mailing Address - Country:US
Mailing Address - Phone:502-805-5858
Mailing Address - Fax:502-805-5859
Practice Address - Street 1:914 LILY CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2815
Practice Address - Country:US
Practice Address - Phone:502-805-5858
Practice Address - Fax:502-805-5859
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31221041C0700X
KY0614106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY124684OtherSIHO - NNS
KY2278675OtherCIGNA - NNS
KY000000712560OtherANTHEM - NNS
KY000057119DOtherHUMANA - NNS
KY124684OtherSIHO - NNS