Basic Information
| Provider Information | |||||||||
| NPI: | 1508028507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THACH | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | THAO | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 RED HILL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927055518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492670400 | ||||||||
| FaxNumber: | 9492210004 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 RED HILL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927055518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492670400 | ||||||||
| FaxNumber: | 9492210004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 03/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | LCSW70065 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.