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NPI Code Detail

MEDICARE: CONNIE S. THOMAS, LMFT

MEDICARE: CONNIE S. THOMAS, LMFT
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1720667942
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONNIE S. THOMAS, LMFT
Provider Business Mailing Address
First Line : 16002 LEGACY RD UNIT 313
Second Line :
City : TUSTIN
State : CA
Zip : 92782-2784
Country : US
Telephone Number : 949-812-0499
Fax Number :
Provider Business Practice Location Address
First Line : 12821 NEWPORT AVE
Second Line :
City : TUSTIN
State : CA
Zip : 92780-2711
Country : US
Telephone Number : 949-812-0499
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : CONNIE SUE THOMAS
Credential : LMFT
Telephone Number : 949-812-0499
Provider Enumeration Date : 04/05/2021
Last Update Date : 04/05/2021

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