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General NPI Number Information
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NPI Number | 1265815492
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Entity Type | Organization
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Legal Business Name | THE STOCKTON THERAPY NETWORK
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 343 E MAIN ST STE 702
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City | STOCKTON
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State | CA
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Zip | 95202-2977
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Country | US
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Telephone | 209-406-8497
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Fax | 209-910-9864
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Provider Business Mailing Address
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Address Line | 343 E MAIN ST STE 702
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City | STOCKTON
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State | CA
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Zip | 95202-2977
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Country | US
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Telephone | 209-406-8497
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS C MAPLES
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Credential | PH.D., LMFT
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Telephone | 209-406-8497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC43057
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License Number State | CA
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