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General NPI Number Information
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NPI Number | 1669505855
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Entity Type | Individual
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Provider Name | MICHELE LEA THOMASON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 1620 CUMMINS DR
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City | MODESTO
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State | CA
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Zip | 95358-6400
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Country | US
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Telephone | 209-595-9735
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Fax |
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Provider Business Mailing Address
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Address Line | 4121 DALE RD APT 27
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City | MODESTO
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State | CA
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Zip | 95356-8601
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Country | US
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Telephone | 209-595-9735
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY21141
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License Number State | CA
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