Provider Demographics
NPI:1235503533
Name:THOMPSON, BRIAN (IMF, CATC-IV)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:IMF, CATC-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28202 CABOT RD STE 331
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1222
Mailing Address - Country:US
Mailing Address - Phone:714-398-5874
Mailing Address - Fax:949-248-2870
Practice Address - Street 1:28202 CABOT RD STE 331
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1222
Practice Address - Country:US
Practice Address - Phone:714-398-5874
Practice Address - Fax:949-248-2870
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154141-IV101YA0400X
CALMFT104710106H00000X
CAIMF93907106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT104710Medicaid
CALMFT104710OtherMANAGED CARE