Provider Demographics
NPI:1619035904
Name:THOMAS, JOLANE (LMFT)
Entity Type:Individual
Prefix:
First Name:JOLANE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 ANITA LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4804
Mailing Address - Country:US
Mailing Address - Phone:949-474-8150
Mailing Address - Fax:949-650-7638
Practice Address - Street 1:1000 QUAIL ST
Practice Address - Street 2:SUITE 155
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2731
Practice Address - Country:US
Practice Address - Phone:949-474-8150
Practice Address - Fax:949-650-7638
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37635106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC37635OtherMARRIAGE & FAMILY COUNSEL