Provider Demographics
NPI:1952596025
Name:THOMAS, JENNIE LORENA (PSYD)
Entity Type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:LORENA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MR
Other - First Name:JIMMIE
Other - Middle Name:LORENZO
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:11344 COLOMA RD STE 605
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4463
Mailing Address - Country:US
Mailing Address - Phone:916-599-9668
Mailing Address - Fax:888-374-0652
Practice Address - Street 1:11344 COLOMA RD STE 605
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4463
Practice Address - Country:US
Practice Address - Phone:916-599-9668
Practice Address - Fax:888-374-0652
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00056469101YP2500X
CAPSB94022230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional