Provider Demographics
NPI:1629484936
Name:THIES, TODD ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ALAN
Last Name:THIES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 2ND ST STE B
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-1110
Mailing Address - Country:US
Mailing Address - Phone:805-215-3047
Mailing Address - Fax:805-888-2744
Practice Address - Street 1:1254 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-1110
Practice Address - Country:US
Practice Address - Phone:805-215-3047
Practice Address - Fax:805-888-2744
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15182103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical