Provider Demographics
NPI:1669605267
Name:TAMI THOMASON
Entity type:Organization
Organization Name:TAMI THOMASON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHIATRIC TECHNICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:408-813-9073
Mailing Address - Street 1:441 GIANNOTTA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1920
Mailing Address - Country:US
Mailing Address - Phone:408-813-9073
Mailing Address - Fax:
Practice Address - Street 1:2001 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1136
Practice Address - Country:US
Practice Address - Phone:408-813-9073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-29
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22554320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness