Provider Demographics
NPI:1689722977
Name:TOMPKINS, JOAN (MFT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:TOMPKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8800 GREEN VALLEY RD SPC 30
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2254
Mailing Address - Country:US
Mailing Address - Phone:707-829-6394
Mailing Address - Fax:
Practice Address - Street 1:8800 GREEN VALLEY RD SPC 30
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-2254
Practice Address - Country:US
Practice Address - Phone:707-829-6394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT46698106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist