Individual
MS. TINA M THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
INTERVENTION PRO.
Contact information
Practice address
3800 W PERUGIA ST APT W204, MERIDIAN, ID 83642-4973
(208) 869-7306
Mailing address
3800 W PERUGIA ST APT W204, MERIDIAN, ID 83642-4973
(208) 869-7306
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0003835
—
ID
Enumeration date
07/19/2019
Last updated
07/19/2019
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