MEDICARE: WENDY M THOMAS

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	111069	TX
2	1041C0700X	Clinical Social Worker
3	101YM0800X	Mental Health Counselor	82368	CA
4	1041C0700X	Clinical Social Worker	107864	CA

General Provider Information

NPI Number	:	1316482441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY M THOMAS

Provider Business Mailing Address
First Line	:	9445 FARNHAM ST
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6160 MISSION GORGE RD STE 108
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-3425
Country	:	US
Telephone Number	:	619-481-5200
Fax Number	:	619-481-5217

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

Provider Enumeration Date	:	12/28/2016
Last Update Date	:	03/02/2026

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Directions to “ WENDY M THOMAS ” Practice Location

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