Healthcare Provider Details

I. General information

NPI: 1285846741
Provider Name (Legal Business Name): KEVIN SCOTT THOMAS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 BARRANCA PKWY STE 260
IRVINE CA
92604-4780
US

IV. Provider business mailing address

4040 BARRANCA PKWY STE 260
IRVINE CA
92604-4780
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 925-282-1778
  • Fax: 415-296-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: