Provider Demographics
NPI:1821251554
Name:THRASHER, ELLEN DELANY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:DELANY
Last Name:THRASHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DELANY
Other - Middle Name:
Other - Last Name:THRASHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:760 WESTWOOD PLZ # C8-749
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-2048
Mailing Address - Country:US
Mailing Address - Phone:310-206-8100
Mailing Address - Fax:310-206-8525
Practice Address - Street 1:760 WESTWOOD PLZ # C8-749
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-2048
Practice Address - Country:US
Practice Address - Phone:310-206-8100
Practice Address - Fax:310-206-8525
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17773103G00000X
CAPSY17773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY177730Medicaid
CACR634ZMedicare PIN