=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811140486
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRI LEE THOMAS LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2008
-----------------------------------------------------
Last Update Date | 10/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 624 WOODWORTH AVE
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93612-1847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-297-6060
-----------------------------------------------------
Fax | 559-297-6061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1720 N FILBERT AVE
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93619-4287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-297-8735
-----------------------------------------------------
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 | MFC 46018
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------