Provider Demographics
NPI:1912307463
Name:THOMPSON, BRIAN WILLIAM (MFTI)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:WILLIAM
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13585 SAN PABLO AVE.,
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3438
Mailing Address - Country:US
Mailing Address - Phone:510-942-4700
Mailing Address - Fax:
Practice Address - Street 1:13585 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-9480
Practice Address - Country:US
Practice Address - Phone:510-942-4700
Practice Address - Fax:510-942-4776
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist