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Individual

MR. DOUGLAS PAUL THOMAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
100 S 1000 W, TOOELE, UT 84074-4010
(435) 843-3520
(435) 843-3555
Mailing address
100 S 1000 W, TOOELE, UT 84074-4010

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
292975-3501
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
107012410101
INTERMOUNTAIN HEALTH CARE
01
29297535000001
BLUE CROSS
01
751648
DESERET MUTUAL
01
94293848015
CHAMPUS
Enumeration date
12/15/2005
Last updated
07/08/2007
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