Healthcare Provider Details

I. General information

NPI: 1386838423
Provider Name (Legal Business Name): THY LOUN ROBLES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THY LOUN LCSW

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 16TH ST
KERMAN CA
93630-1997
US

IV. Provider business mailing address

2195 UNION AVE
FAIRFIELD CA
94534-9613
US

V. Phone/Fax

Practice location:
  • Phone: 530-304-9729
  • Fax:
Mailing address:
  • Phone: 707-422-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW66248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: