=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386299535
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAIGE THOMPSON PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2019
-----------------------------------------------------
Last Update Date | 02/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1902 WRIGHT PL STE 200
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92008-6583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-621-3122
-----------------------------------------------------
Fax | 503-836-3784
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 CENTER DR # 105-7083
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92069-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY34693
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------