Provider Demographics
NPI:1336401561
Name:MONTROSS THOMAS, LORI P (PHD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:P
Last Name:MONTROSS THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 GILMAN DR DEPT 664
Mailing Address - Street 2:UNIVERSITY OF CALIFORNIA SAN DIEGO
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0664
Mailing Address - Country:US
Mailing Address - Phone:619-206-9962
Mailing Address - Fax:
Practice Address - Street 1:9500 GILMAN DR DEPT 664
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA SAN DIEGO
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0664
Practice Address - Country:US
Practice Address - Phone:619-206-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25412103TC1900X
CAPSB36789103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist