Provider Demographics
NPI:1225252968
Name:THAO, GE
Entity Type:Individual
Prefix:
First Name:GE
Middle Name:
Last Name:THAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 MILES CT STE B
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-4300
Mailing Address - Country:US
Mailing Address - Phone:209-819-9974
Mailing Address - Fax:209-384-7384
Practice Address - Street 1:1748 MILES CT STE B
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-4300
Practice Address - Country:US
Practice Address - Phone:209-819-9974
Practice Address - Fax:209-384-7384
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW29656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health