Provider Demographics
NPI:1083745780
Name:SOUNTHALA, THEPPHARACK AD (MSW)
Entity Type:Individual
Prefix:MRS
First Name:THEPPHARACK
Middle Name:AD
Last Name:SOUNTHALA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E HACKETT RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-9415
Mailing Address - Country:US
Mailing Address - Phone:209-558-2699
Mailing Address - Fax:209-558-1075
Practice Address - Street 1:251 E HACKETT RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-9415
Practice Address - Country:US
Practice Address - Phone:209-558-2699
Practice Address - Fax:209-558-1075
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW262251041C0700X
CALCS 26225101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional