Provider Demographics
NPI:1568279412
Name:THOMAS, PRESTON PRINCE III (RBT)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:PRINCE
Last Name:THOMAS
Suffix:III
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6228 FILBERT AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4106
Mailing Address - Country:US
Mailing Address - Phone:916-945-6173
Mailing Address - Fax:
Practice Address - Street 1:6228 FILBERT AVE STE 3
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4106
Practice Address - Country:US
Practice Address - Phone:916-945-6173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician