Healthcare Provider Details

I. General information

NPI: 1649671314
Provider Name (Legal Business Name): JEAN THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N MARENGO AVE STE 200
PASADENA CA
91101-1746
US

IV. Provider business mailing address

66 HURLBUT ST
PASADENA CA
91105-4025
US

V. Phone/Fax

Practice location:
  • Phone: 626-585-8075
  • Fax:
Mailing address:
  • Phone: 626-441-4221
  • Fax: 626-441-6479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: