Provider Demographics
NPI:1366086464
Name:THOMAS, TERRY LOUIS (AMFT)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LOUIS
Last Name:THOMAS
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 MONTEZUMA ST
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571-1622
Mailing Address - Country:US
Mailing Address - Phone:707-374-5243
Mailing Address - Fax:
Practice Address - Street 1:628 MONTEZUMA ST
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:CA
Practice Address - Zip Code:94571-1622
Practice Address - Country:US
Practice Address - Phone:707-374-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10007731101YM0800X
101YM0800X
CAAMFT114070101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health