Provider Demographics
NPI:1265169502
Name:THE THOUGHT SHOPPE
Entity type:Organization
Organization Name:THE THOUGHT SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:AMBER
Authorized Official - Last Name:PACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT 125086
Authorized Official - Phone:657-339-2252
Mailing Address - Street 1:7412 JOSHUA LN
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3747
Mailing Address - Country:US
Mailing Address - Phone:714-458-5121
Mailing Address - Fax:
Practice Address - Street 1:7412 JOSHUA LN
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3747
Practice Address - Country:US
Practice Address - Phone:714-458-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty