Provider Demographics
NPI:1295920577
Name:MAPLES, THOMAS C (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:MAPLES
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 COUNTRY CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-4822
Mailing Address - Country:US
Mailing Address - Phone:209-464-1995
Mailing Address - Fax:
Practice Address - Street 1:1908 COUNTRY CLUB BLVD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-4822
Practice Address - Country:US
Practice Address - Phone:209-464-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43057106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist