Provider Demographics
NPI:1740551407
Name:THOMASON, EMMETT LEIGH III (MA)
Entity type:Individual
Prefix:MR
First Name:EMMETT
Middle Name:LEIGH
Last Name:THOMASON
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:TRAY
Other - Middle Name:
Other - Last Name:THOMASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:125 W MISSION AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1720
Mailing Address - Country:US
Mailing Address - Phone:760-747-3424
Mailing Address - Fax:760-747-3435
Practice Address - Street 1:125 W MISSION AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1720
Practice Address - Country:US
Practice Address - Phone:760-747-3424
Practice Address - Fax:760-747-3435
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51786106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist