Healthcare Provider Details

I. General information

NPI: 1831536028
Provider Name (Legal Business Name): JEFFERY EARL THOMAS SR. LPCC,LAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 OCEAN FRONT WALK
VENICE CA
90291-2403
US

IV. Provider business mailing address

503 OCEAN FRONT WALK
VENICE CA
90291-2403
US

V. Phone/Fax

Practice location:
  • Phone: 310-392-3070
  • Fax: 310-557-8989
Mailing address:
  • Phone: 310-392-3070
  • Fax: 310-557-8989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC17264
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: