1659395002 NPI number — MR. THOMAS FORRAY LMFT -CALIFORNIA

Table of content: MR. THOMAS FORRAY LMFT -CALIFORNIA (NPI 1659395002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659395002 NPI number — MR. THOMAS FORRAY LMFT -CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORRAY
Provider First Name:
THOMAS
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMFT -CALIFORNIA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659395002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 BON AIR RD
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
GREENBRAE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94904-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-299-9847
Provider Business Mailing Address Fax Number:
415-507-4160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 BON AIR RD
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
GREENBRAE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94904-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-299-9847
Provider Business Practice Location Address Fax Number:
415-507-4160
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MF 15861 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MF 15861 . This is a "LIC. MARRIAGE/FAMILY THER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 24731 . This is a "MASTER ADDICTIONS COUNS." identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 16637 . This is a "CERT. CRIMINAL JUSTICE SP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com