Basic Information
| Provider Information | |||||||||
| NPI: | 1376053132 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | TAMARA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RAC-12528 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24953 PASEO DE VALENCIA BLDG B, STE. 1B | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926534342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495400170 | ||||||||
| FaxNumber: | 9495400173 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 W 6TH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927032101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149721402 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2017 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | RAC12528 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.