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NPI Code Detail

MEDICARE: MICHELE THOMASON, PH.D.

MEDICARE: MICHELE THOMASON, PH.D.
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
1103TC0700XClinical PsychologistPSY21141CA

General Provider Information

NPI Number : 1902359722
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHELE THOMASON, PH.D.
Provider Business Mailing Address
First Line : 1111 W ROBINHOOD DR STE D
Second Line :
City : STOCKTON
State : CA
Zip : 95207-5626
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1111 W ROBINHOOD DR STE D
Second Line :
City : STOCKTON
State : CA
Zip : 95207-5626
Country : US
Telephone Number : 209-595-9735
Fax Number :
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : DR. MICHELE THOMASON
Credential : PH.D.
Telephone Number : 209-595-9735
Provider Enumeration Date : 07/28/2016
Last Update Date : 07/28/2016

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