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General NPI Number Information
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NPI Number | 1669605267
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Entity Type | Organization
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Legal Business Name | TAMI THOMASON
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Dates
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Enumeration Date | 08/29/2009
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 2001 THE ALAMEDA
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City | SAN JOSE
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State | CA
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Zip | 95126-1136
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Country | US
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Telephone | 408-813-9073
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Fax |
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Provider Business Mailing Address
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Address Line | 441 GIANNOTTA WAY
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City | SAN JOSE
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State | CA
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Zip | 95133-1920
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Country | US
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Telephone | 408-813-9073
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHIATRIC TECHNICIAN
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Name | MRS. TAMI M THOMASON
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Credential | LPT
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Telephone | 408-813-9073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | PT22554
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License Number State | CA
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