Healthcare Provider Details

I. General information

NPI: 1306082011
Provider Name (Legal Business Name): THELMISHA VINCENT BCBA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 GRAND AVE STE 500
OAKLAND CA
94612-3747
US

IV. Provider business mailing address

DEPT LA 22763
PASADENA CA
91185-2763
US

V. Phone/Fax

Practice location:
  • Phone: 866-523-4268
  • Fax:
Mailing address:
  • Phone: 866-523-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3317
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00395
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: