Provider Demographics
NPI:1093524225
Name:MCRAE-THOMPSON, THANE NATHANIEL (SWLC)
Entity type:Individual
Prefix:
First Name:THANE
Middle Name:NATHANIEL
Last Name:MCRAE-THOMPSON
Suffix:
Gender:M
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 RIVER CT
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1469
Mailing Address - Country:US
Mailing Address - Phone:406-439-0095
Mailing Address - Fax:
Practice Address - Street 1:625 RIVER CT
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1469
Practice Address - Country:US
Practice Address - Phone:406-439-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical