Provider Demographics
NPI:1962675827
Name:THRIFT, WALIDAH K (LMFT)
Entity Type:Individual
Prefix:
First Name:WALIDAH
Middle Name:K
Last Name:THRIFT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27710 JEFFERSON AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4604
Mailing Address - Country:US
Mailing Address - Phone:951-970-9931
Mailing Address - Fax:
Practice Address - Street 1:27710 JEFFERSON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4604
Practice Address - Country:US
Practice Address - Phone:951-970-9931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53052106H00000X
WA60304895101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health