MEDICARE: PORTER THOMPSON LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	225700000X	Massage Therapist
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1891268074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTER THOMPSON LLC

Provider Business Mailing Address
First Line	:	6076 CLAREMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94618-1223
Country	:	US
Telephone Number	:	415-286-5156
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 FLORIO ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94618-1333
Country	:	US
Telephone Number	:	415-286-5156
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MRS. ARIADNE THOMPSON
Credential	:	LMFT
Telephone Number	:	415-286-5156

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	01/10/2019

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Directions to “PORTER THOMPSON LLC ” Practice Location

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