MEDICARE: MRS. LINDA MARIE THOMPSON MFT

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	106H00000X	Marriage & Family Therapist	40791	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356489777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA MARIE THOMPSON MFT

Provider Business Mailing Address
First Line	:	PO BOX 6293
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-0993
Country	:	US
Telephone Number	:	650-670-5108
Fax Number	:	650-458-8568

Provider Business Practice Location Address
First Line	:	122 2ND AVE
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94401-3856
Country	:	US
Telephone Number	:	650-670-5108
Fax Number	:	650-458-8568

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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