Provider Demographics
NPI:1881731206
Name:THOMPSON, JUDITH L (MFT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 EAST AVE STE 124 PMB 173
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973
Mailing Address - Country:US
Mailing Address - Phone:530-592-6322
Mailing Address - Fax:530-636-4888
Practice Address - Street 1:1074 EAST AVE STE A4
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1052
Practice Address - Country:US
Practice Address - Phone:530-592-6322
Practice Address - Fax:530-636-4888
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT41343106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist