Provider Demographics
NPI:1639398548
Name:THURLOW, ROANLD GENE (PHD MFT)
Entity Type:Individual
Prefix:DR
First Name:ROANLD
Middle Name:GENE
Last Name:THURLOW
Suffix:
Gender:M
Credentials:PHD MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4559 STRATFORD CIR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4905
Mailing Address - Country:US
Mailing Address - Phone:760-753-1150
Mailing Address - Fax:760-753-1150
Practice Address - Street 1:4559 STRATFORD CIR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4905
Practice Address - Country:US
Practice Address - Phone:760-842-7006
Practice Address - Fax:760-842-7006
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25189106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist