Provider Demographics
NPI:1356363303
Name:THRIST, THOMETHIA REGINA (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:THOMETHIA
Middle Name:REGINA
Last Name:THRIST
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 LOS CIMAS DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-8150
Mailing Address - Country:US
Mailing Address - Phone:314-210-0192
Mailing Address - Fax:
Practice Address - Street 1:6530 LOS CIMAS DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-8150
Practice Address - Country:US
Practice Address - Phone:314-210-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010040159101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional