Provider Demographics
NPI:1962880948
Name:THOMPSON, REBECCA T (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:T
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 AMERICAN RIVER DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5922
Mailing Address - Country:US
Mailing Address - Phone:916-574-1000
Mailing Address - Fax:916-574-1001
Practice Address - Street 1:3610 AMERICAN RIVER DR
Practice Address - Street 2:SUITE 140
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5922
Practice Address - Country:US
Practice Address - Phone:916-574-1000
Practice Address - Fax:916-574-1001
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27184103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist