Basic Information
| Provider Information | |||||||||
| NPI: | 1053399972 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2265 COMO AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551081737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516468985 | ||||||||
| FaxNumber: | 6516463959 | ||||||||
| Practice Location | |||||||||
| Address1: | 2265 COMO AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551081737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516468985 | ||||||||
| FaxNumber: | 6516463959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 3025 | MN | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TC1900X | 3025 | MN | X | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TC2200X | 3025 | MN | X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TF0000X | 3025 | MN | X | Behavioral Health & Social Service Providers | Psychologist | Family | 103T00000X | 3025 | MN | X | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 407L1TH | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 6255739 | 01 | MN | MEDICA/UBH | OTHER | 1043470 | 01 | MN | PREFERRED ONE | OTHER |