Healthcare Provider Details

I. General information

NPI: 1437061447
Provider Name (Legal Business Name): MARIE LANETT THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W METROPOLITAN DR
ORANGE CA
92868-3504
US

IV. Provider business mailing address

12857 FREDERICK ST APT 308
MORENO VALLEY CA
92553-4502
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-8991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: