MEDICARE: PATRINA GEORGIAMARIE THOMPSON STEPTOE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1013103035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRINA GEORGIAMARIE THOMPSON STEPTOE

Provider Business Mailing Address
First Line	:	24197 DRESSIN DR
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-5106
Country	:	US
Telephone Number	:	951-486-0072
Fax Number	:	951-486-0072

Provider Business Practice Location Address
First Line	:	3050 CHICAGO AVE
Second Line	:	SUITE 180
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-3418
Country	:	US
Telephone Number	:	951-686-8500
Fax Number	:	951-686-8565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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