MEDICARE: MR. JOHN OLIVER THOMASSON JR. MHRS, RAS, CCBT

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	101Y00000X	Counselor		CA

General Provider Information

NPI Number	:	1659488906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN OLIVER THOMASSON JR. MHRS, RAS, CCBT

Provider Business Mailing Address
First Line	:	2450 FLORIN RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-4405
Country	:	US
Telephone Number	:	916-875-3896
Fax Number	:

Provider Business Practice Location Address
First Line	:	4433 FLORIN RD
Second Line	:	SUITE 600, RM 612
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2527
Country	:	US
Telephone Number	:	916-875-3896
Fax Number	:	916-875-4207

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	05/09/2019

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