Provider Demographics
NPI:1184247744
Name:THOMAS, JENNIFER ANN (MS, LPCC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:
Credentials:MS, LPCC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPCC
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:MERRIFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56465-0141
Mailing Address - Country:US
Mailing Address - Phone:218-514-7062
Mailing Address - Fax:218-217-4071
Practice Address - Street 1:18510 STATE HIGHWAY 371 STE B
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-6996
Practice Address - Country:US
Practice Address - Phone:218-514-7062
Practice Address - Fax:218-217-4071
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QM0801X
MN2494101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)