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General NPI Number Information
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NPI Number | 1902359722
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Entity Type | Organization
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Legal Business Name | MICHELE THOMASON, PH.D.
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 1111 W ROBINHOOD DR STE D
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City | STOCKTON
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State | CA
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Zip | 95207-5626
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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 | 1111 W ROBINHOOD DR STE D
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City | STOCKTON
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State | CA
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Zip | 95207-5626
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. MICHELE THOMASON
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Credential | PH.D.
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Telephone | 209-595-9735
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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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