Provider Demographics
NPI:1578245569
Name:THULEMEYER, JEREMY ERIC
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ERIC
Last Name:THULEMEYER
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 1:1330 N GARDNER ST APT 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4151
Mailing Address - Country:US
Mailing Address - Phone:714-392-0978
Mailing Address - Fax:
Practice Address - Street 1:1212 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1769
Practice Address - Country:US
Practice Address - Phone:800-530-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140392106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist