MEDICARE: GERALD THAUBERGER M.S.

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	101YP2500X	Professional Counselor	LPCC1855	CA
2	106H00000X	Marriage & Family Therapist	LMFT33242	CA

General Provider Information

NPI Number	:	1255353793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD THAUBERGER M.S.

Provider Business Mailing Address
First Line	:	13900 LAKE WILDWOOD DR
Second Line	:
City	:	PENN VALLEY
State	:	CA
Zip	:	95946-9592
Country	:	US
Telephone Number	:	530-615-4570
Fax Number	:	530-615-4570

Provider Business Practice Location Address
First Line	:	1095 STAFFORD WAY STE E
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-3333
Country	:	US
Telephone Number	:	530-615-4570
Fax Number	:	530-615-4570

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	03/17/2018

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