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NPI Code Detail

MEDICARE: LAUREN THIBODEAU MFT

MEDICARE: LAUREN THIBODEAU 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
1106H00000XMarriage & Family Therapist127601CA

General Provider Information

NPI Number : 1710718119
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN THIBODEAU MFT
Provider Business Mailing Address
First Line : 12396 WORLD TRADE DR STE 204
Second Line :
City : SAN DIEGO
State : CA
Zip : 92128-3789
Country : US
Telephone Number : 760-942-8663
Fax Number :
Provider Business Practice Location Address
First Line : 12396 WORLD TRADE DR STE 204
Second Line :
City : SAN DIEGO
State : CA
Zip : 92128-3789
Country : US
Telephone Number : 760-942-8663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2024
Last Update Date : 08/08/2024

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Directions to “ LAUREN THIBODEAU MFT” Practice Location

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