Healthcare Provider Details

I. General information

NPI: 1811140486
Provider Name (Legal Business Name): TERRI LEE THOMAS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 WOODWORTH AVE
CLOVIS CA
93612-1847
US

IV. Provider business mailing address

1720 N FILBERT AVE
CLOVIS CA
93619-4287
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-6060
  • Fax: 559-297-6061
Mailing address:
  • Phone: 559-297-8735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 46018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: