Provider Demographics
NPI:1801141247
Name:THOMPSON, KATHRYN DEBRA
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:DEBRA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:DEBRA
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 LUPE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3227
Mailing Address - Country:US
Mailing Address - Phone:805-558-6537
Mailing Address - Fax:
Practice Address - Street 1:2055 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3608
Practice Address - Country:US
Practice Address - Phone:805-483-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2022-03-15
Deactivation Date:2022-02-23
Deactivation Code:
Reactivation Date:2022-03-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)