Provider Demographics
NPI:1598105173
Name:OBERLY, THALIA GISELLE
Entity Type:Individual
Prefix:
First Name:THALIA
Middle Name:GISELLE
Last Name:OBERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THALIA
Other - Middle Name:GISELLE
Other - Last Name:VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:505 N EUCLID ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5514
Mailing Address - Country:US
Mailing Address - Phone:714-450-4219
Mailing Address - Fax:
Practice Address - Street 1:222 S HARBOR BLVD STE 650
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3756
Practice Address - Country:US
Practice Address - Phone:714-450-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118599106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist