Provider Demographics
NPI:1972076974
Name:THOMPSON, ATIYYAH JASMIN
Entity type:Individual
Prefix:
First Name:ATIYYAH
Middle Name:JASMIN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ATIYYAH
Other - Middle Name:JASMIN
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1232 OAKHEATH DR
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1223
Mailing Address - Country:US
Mailing Address - Phone:424-603-8377
Mailing Address - Fax:
Practice Address - Street 1:805 MAIN ST STE L
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4457
Practice Address - Country:US
Practice Address - Phone:424-603-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2023-08-23
Deactivation Date:2021-09-10
Deactivation Code:
Reactivation Date:2021-10-05
Provider Licenses
StateLicense IDTaxonomies
CA46-0508169103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst