Provider Demographics
NPI:1134321474
Name:THOMSEN, GARY (MFT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:THOMSEN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GRAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-5054
Mailing Address - Country:US
Mailing Address - Phone:510-834-4006
Mailing Address - Fax:510-834-4010
Practice Address - Street 1:401 GRAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-5054
Practice Address - Country:US
Practice Address - Phone:510-834-4006
Practice Address - Fax:510-834-4010
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35176106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist