Provider Demographics
NPI:1811285463
Name:THOMAS, MARION (LCSW-BACS, ACSW)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW-BACS, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13305 ECTOR DR
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-4653
Mailing Address - Country:US
Mailing Address - Phone:225-775-0003
Mailing Address - Fax:
Practice Address - Street 1:13305 ECTOR DR
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4653
Practice Address - Country:US
Practice Address - Phone:225-775-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14031041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1621765Medicaid
LA4H370Medicare UPIN