Provider Demographics
NPI:1629939533
Name:THOMAS, JUSTIN RAYMOND (MA,LADC,LPCC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:RAYMOND
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MA,LADC,LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALLINA HEALTH NININGER ROAD CLINIC
Mailing Address - Street 2:1285 NININGER ROAD
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1086
Mailing Address - Country:US
Mailing Address - Phone:651-404-1400
Mailing Address - Fax:651-404-1140
Practice Address - Street 1:ALLINA HEALTH NININGER ROAD CLINIC
Practice Address - Street 2:1285 NININGER ROAD
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1086
Practice Address - Country:US
Practice Address - Phone:651-404-1400
Practice Address - Fax:651-404-1140
Is Sole Proprietor?:No
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLADC-305434101YA0400X
MNLPCC-5018101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health