=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942403480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL J THOMSEN MFT, M.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 S. WASHINGTON AVE. #12
-----------------------------------------------------
City | SONORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-536-9885
-----------------------------------------------------
Fax | 209-536-9885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 3504
-----------------------------------------------------
City | SONORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-536-9885
-----------------------------------------------------
Fax | 209-536-9885
-----------------------------------------------------
=====================================================
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 | MFC30494
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------