Provider Demographics
NPI:1821529447
Name:THOMAS, MALINDA JO (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:JO
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 E TRIUMPHAVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854
Mailing Address - Country:US
Mailing Address - Phone:208-625-9361
Mailing Address - Fax:
Practice Address - Street 1:1320 E TRIUMPH AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5985
Practice Address - Country:US
Practice Address - Phone:208-625-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2024-07-30
Deactivation Date:2024-07-12
Deactivation Code:
Reactivation Date:2024-07-30
Provider Licenses
StateLicense IDTaxonomies
WACP 60704296101YA0400X
WALH61540790101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)