KRISTINE MARIE THACKREY LISW LICDC NPI 1497819916

NPI Information

NPI: 1497819916
Provider Name: KRISTINE MARIE THACKREY, LISW, LICDC
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

PECOS Registration: Yes

Address:
3611 S DIXIE HWY
LIMA, OH
ZIP 45804
Phone: (419) 999-2024
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Kristine Marie Thackrey, LISW, LICDC is an addiction (substance use disorder) counselor in Lima, OH with 34 years of experience. Kristine Marie Thackrey, LISW, LICDC NPI is 1497819916. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3611 S DIXIE HWY
LIMA, OH
ZIP 45804-750
Phone: (419) 999-2024
Fax: (419) 999-2024

The NPI 1497819916 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 12/20/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	933608	OHIO	Yes
2	1041C0700X	Social Worker	Clinical	I5522	OHIO	X

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000000352379	OTHER	OHIO	ANTHEM BLUE CROSS AND BLU

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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