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NPI Code Detail

MEDICARE: CRISTY THOM

MEDICARE: CRISTY THOM
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
1390200000XStudent in an Organized Health Care Education/Training Program
2106H00000XMarriage & Family Therapist140179CA
3106H00000XMarriage & Family Therapist162161CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17184OTHERCAMEDICAL
27708OTHERCAMEDICAL
37368OTHERCAMEDICAL
47667OTHERCAMEDICAL

General Provider Information

NPI Number : 1578214102
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRISTY THOM
Provider Business Mailing Address
First Line : 205 PASADENA AVE
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-2919
Country : US
Telephone Number : 323-344-5536
Fax Number : 323-344-5550
Provider Business Practice Location Address
First Line : 205 PASADENA AVE
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-2919
Country : US
Telephone Number : 323-344-5536
Fax Number : 323-344-5550
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2022
Last Update Date : 03/11/2026

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