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General NPI Number Information
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NPI Number | 1114324167
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Entity Type | Individual
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Provider Name | GREGORY ROBERT TOMPKINS MFTI
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Gender | Male
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 1 SAINT VINCENTS DR
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1504
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Country | US
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Telephone | 415-507-4209
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Fax |
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Provider Business Mailing Address
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Address Line | 1 SAINT VINCENTS DR
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1504
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Country | US
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Telephone | 415-507-4209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 112495
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | AMFT112495
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License Number State | CA
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