Provider Demographics
NPI:1912420456
Name:THOMAS, EMILY JILL (LCPC, NCC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JILL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 E 200 N
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-5602
Mailing Address - Country:US
Mailing Address - Phone:208-206-3742
Mailing Address - Fax:
Practice Address - Street 1:1785 LILY POND CIR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-2197
Practice Address - Country:US
Practice Address - Phone:208-206-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6545101Y00000X
UT13173266-6004101YM0800X
AZLPC-23483101YP2500X
NVCP5540-R101YP2500X
IDLCPC-7599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional