Provider Demographics
NPI:1013088129
Name:THOMAS, GAINES A (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAINES
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N 6TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7514
Mailing Address - Country:US
Mailing Address - Phone:559-435-8700
Mailing Address - Fax:559-435-8700
Practice Address - Street 1:5100 N 6TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7514
Practice Address - Country:US
Practice Address - Phone:559-435-8700
Practice Address - Fax:559-435-8700
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6844103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOPL68440Medicare ID - Type Unspecified
CAS99878Medicare UPIN