Healthcare Provider Details

I. General information

NPI: 1265678981
Provider Name (Legal Business Name): GER THAO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 N GATEWAY BLVD
FRESNO CA
93727-1604
US

IV. Provider business mailing address

1960 N GATEWAY BLVD
FRESNO CA
93727-1604
US

V. Phone/Fax

Practice location:
  • Phone: 559-266-5200
  • Fax: 559-266-5201
Mailing address:
  • Phone: 559-266-5200
  • Fax: 559-266-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW25653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: