Healthcare Provider Details

I. General information

NPI: 1891109716
Provider Name (Legal Business Name): KATHLEEN THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 12/07/2019
Certification Date: 12/07/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 BRODER BLVD
DUBLIN CA
94568-3309
US

IV. Provider business mailing address

4361 RAILROAD AVE
PLEASANTON CA
94566-6611
US

V. Phone/Fax

Practice location:
  • Phone: 105-589-4536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number100088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: