Provider Demographics
NPI:1649750944
Name:THOMAS, JENNIFER RAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RAY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 TUNNEL HILL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7913
Mailing Address - Country:US
Mailing Address - Phone:270-312-5734
Mailing Address - Fax:
Practice Address - Street 1:1106 TUNNEL HILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-765-2335
Practice Address - Fax:270-765-2557
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2524041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical