Healthcare Provider Details

I. General information

NPI: 1831008697
Provider Name (Legal Business Name): THOMAS PATRICK BAXLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 MASON ST STE 205
VACAVILLE CA
95688-4548
US

IV. Provider business mailing address

2010A HARBISON DR # 632
VACAVILLE CA
95687-3900
US

V. Phone/Fax

Practice location:
  • Phone: 650-888-8979
  • Fax:
Mailing address:
  • Phone: 650-888-8979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number26303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: