Provider Demographics
NPI:1669227666
Name:THOMPSON, VANESSA ARLENE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ARLENE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:ARLENE
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45546 ALADDIN ST APT C204
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3882
Mailing Address - Country:US
Mailing Address - Phone:442-290-9989
Mailing Address - Fax:
Practice Address - Street 1:79100 OCOTILLO DR
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-5915
Practice Address - Country:US
Practice Address - Phone:760-834-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician