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NPI Code Detail

MEDICARE: STACEY THOMAS

MEDICARE: STACEY THOMAS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1386410264
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY THOMAS
Provider Business Mailing Address
First Line : 2424 OAK HILL ST
Second Line :
City : STOCKTON
State : CA
Zip : 95206-4725
Country : US
Telephone Number : 209-487-3469
Fax Number :
Provider Business Practice Location Address
First Line : 10898 BOESSOW RD
Second Line :
City : GALT
State : CA
Zip : 95632-8451
Country : US
Telephone Number : 209-412-2389
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2023
Last Update Date : 11/30/2023

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Directions to “ STACEY THOMAS ” Practice Location

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