Provider Demographics
NPI:1710177050
Name:THOMSON, BRIAN (MFT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:THOMSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N. ORANGE ST.
Mailing Address - Street 2:SUITE E
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3242
Mailing Address - Country:US
Mailing Address - Phone:909-641-2603
Mailing Address - Fax:
Practice Address - Street 1:550 N. ORANGE ST.
Practice Address - Street 2:SUITE E
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3242
Practice Address - Country:US
Practice Address - Phone:909-641-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37312106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist