Healthcare Provider Details

I. General information

NPI: 1285404533
Provider Name (Legal Business Name): KAMELAH THOMPSON MBSAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 W VICTORIA ST
LONG BEACH CA
90805-2175
US

IV. Provider business mailing address

5378 LONG BEACH BLVD STE 136
LONG BEACH CA
90805-5858
US

V. Phone/Fax

Practice location:
  • Phone: 562-475-3811
  • Fax:
Mailing address:
  • Phone: 562-519-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: