MEDICARE: CHRISTA THOMPSON LCSW

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	1041C0700X	Clinical Social Worker	68028	CA

General Provider Information

NPI Number	:	1164713343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTA THOMPSON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 251
Second Line	:
City	:	MOUNTAIN RANCH
State	:	CA
Zip	:	95246-0251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 W SAINT CHARLES ST
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249
Country	:	US
Telephone Number	:	209-813-2083
Fax Number	:

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

Provider Enumeration Date	:	04/22/2011
Last Update Date	:	08/26/2015

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