Provider Demographics
NPI:1508524299
Name:TODD-THOMAS, MARY CHERIE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CHERIE
Last Name:TODD-THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CHERIE
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10682 N SPANISH BAY DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-5936
Mailing Address - Country:US
Mailing Address - Phone:559-708-7635
Mailing Address - Fax:
Practice Address - Street 1:3894 E GETTYSBURG AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0901
Practice Address - Country:US
Practice Address - Phone:559-454-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor