Provider Demographics
NPI:1659488906
Name:THOMASSON, JOHN OLIVER JR (MHRS, RAS, CCBT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:OLIVER
Last Name:THOMASSON
Suffix:JR
Gender:M
Credentials:MHRS, RAS, CCBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4405
Mailing Address - Country:US
Mailing Address - Phone:916-875-3896
Mailing Address - Fax:
Practice Address - Street 1:4433 FLORIN RD
Practice Address - Street 2:SUITE 600, RM 612
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2527
Practice Address - Country:US
Practice Address - Phone:916-875-3896
Practice Address - Fax:916-875-4207
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty