Healthcare Provider Details

I. General information

NPI: 1801141247
Provider Name (Legal Business Name): MRS. KATHRYN DEBRA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS KATHRYN DEBRA ROSE

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date: 02/23/2022
Reactivation Date: 03/14/2022

III. Provider practice location address

2055 SAVIERS RD
OXNARD CA
93033-3608
US

IV. Provider business mailing address

121 LUPE AVE
NEWBURY PARK CA
91320-3227
US

V. Phone/Fax

Practice location:
  • Phone: 805-483-2253
  • Fax:
Mailing address:
  • Phone: 805-558-6537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: