=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730738220
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. LEONNE THATCHER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2019
-----------------------------------------------------
Last Update Date | 09/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3037 INDEPENDENCE DR
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94551-7670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-443-3434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1534 ARATA CT
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95125-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-348-1196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 92456
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------