Provider Demographics
NPI:1497874770
Name:THOMAS, COLIN DAVID (LMFT)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:DAVID
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12440 COOKACRE AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-5357
Mailing Address - Country:US
Mailing Address - Phone:503-347-7577
Mailing Address - Fax:
Practice Address - Street 1:714 W OLYMPIC BLVD STE 704
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1439
Practice Address - Country:US
Practice Address - Phone:310-712-3411
Practice Address - Fax:213-749-1875
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115350106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health