MEDICARE: MICHAELA TAYLOR THOMPSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1275206294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA TAYLOR THOMPSON

Provider Business Mailing Address
First Line	:	1133 COLOMA WAY STE C
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-4480
Country	:	US
Telephone Number	:	916-774-6647
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 INDUSTRIAL BLVD # 600
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3496
Country	:	US
Telephone Number	:	916-542-9516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	05/26/2025

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