Individual provider Active NPI

Randall Thomas Jr.

  • Licensed Psychiatric Technician
  • San Luis Obispo, CA
National Provider Identifier
1043633902
Registry record updated Feb 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Psychiatric TechnicianTaxonomy code 167G00000X
License
34530 Issued in CA
Practice address
2975 McMillan Ave Ste 164
San Luis Obispo, CA 93401-6768
Phone
(805) 438-3890
NPI assigned
Jan 29, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Psychiatric Technician 167G00000X 34530 CA Primary
Day Training/Habilitation Specialist 373H00000X

Addresses

Primary practice location

2975 McMillan Ave Ste 164
San Luis Obispo, CA 93401-6768

Mailing address

2975 McMillan Ave Ste 164
San Luis Obispo, CA 93401-6768
Phone (805) 438-3890

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
34530CAMDLicensed Psychiatric Technician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1390953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769990400000",
    "number": "1043633902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 MCMILLAN AVE STE 164",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016768",
            "telephone_number": "805-438-3890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 MCMILLAN AVE STE 164",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016768",
            "telephone_number": "805-438-3890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "RANDALL",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-29",
        "last_updated": "2026-02-02",
        "certification_date": "2026-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "34530",
            "primary": true
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.