Active NPI
Jack Robert Thomas, MA
- Mental Health Counselor
- Mount Vernon, WA
National Provider Identifier
1912004888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- RC00036751
- Practice address
- 1100 S 2ND St
Mount Vernon, WA 98273-4209 - Phone
- (364) 193-5513
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | RC00036751 | WA | Primary |
Addresses
Primary practice location
1100 S 2ND St
Mount Vernon, WA 98273-4209
Mailing address
PO Box 1307
La Conner, WA 98257-1307
Phone (360) 466-0130
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RC00036751 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912004888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1307",
"city": "LA CONNER",
"state": "WA",
"postal_code": "982571307",
"telephone_number": "360-466-0130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 S 2ND ST",
"city": "MOUNT VERNON",
"state": "WA",
"postal_code": "982734209",
"telephone_number": "364-193-5513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "JACK",
"middle_name": "ROBERT",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "RC00036751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.