Provider Demographics
NPI:1912053174
Name:THOMAS, KRISTEN SARAH (MS, LLP, LPCC)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:SARAH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, LLP, LPCC
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:SARAH
Other - Last Name:MCCLELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LLP
Mailing Address - Street 1:1481 S TRAIL CIR
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-7071
Mailing Address - Country:US
Mailing Address - Phone:734-673-9190
Mailing Address - Fax:
Practice Address - Street 1:38875 LYNDON ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-673-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00084101YP2500X
MI6301012278103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1912053174OtherMEDICAL ASSISTANCE (MA)
MN1912053174OtherBLUE CROSS BLUE SHIELD
MN1912053174OtherHEALTH PARTNERS