Provider Demographics
NPI:1376011767
Name:THOMAS, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S GLENDORA AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-6207
Mailing Address - Country:US
Mailing Address - Phone:626-600-8601
Mailing Address - Fax:
Practice Address - Street 1:410 S GLENDORA AVE STE 130
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-6207
Practice Address - Country:US
Practice Address - Phone:626-600-8601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2020-04-12
Deactivation Date:2018-11-08
Deactivation Code:
Reactivation Date:2020-03-25
Provider Licenses
StateLicense IDTaxonomies
CALMFT109799106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist