Provider Demographics
NPI:1194786749
Name:THOMAS, LINDA M (LICSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-1148
Mailing Address - Country:US
Mailing Address - Phone:701-837-6508
Mailing Address - Fax:701-858-1839
Practice Address - Street 1:3314 33RD ST SW
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5158
Practice Address - Country:US
Practice Address - Phone:701-837-6508
Practice Address - Fax:701-858-1839
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19148Medicaid
ND26470OtherBLUE CROSS BLUE SHIELD ND
ND711734Medicare ID - Type Unspecified