Provider Demographics
NPI:1649395732
Name:THOMAS-MCGREGOR, SUSAN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:THOMAS-MCGREGOR
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:SUAN
Other - Middle Name:
Other - Last Name:THOMAS-REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:2100 FIRST AVENUE SOUTH
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-418-5637
Mailing Address - Fax:612-235-6481
Practice Address - Street 1:2100 FIRST AVENUE SOUTH
Practice Address - Street 2:SUITE 204
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-418-5637
Practice Address - Fax:612-235-6481
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1393106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA131613300Medicaid