Shella R Thorson, PT
Individual provider Active NPI Licensed Psychiatric Technician · Indio, CA
NPI 1609645720 · NPPES record last updated Dec 29, 2023
Key facts
- NPI
- 1609645720
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Psychiatric Technician 167G00000X
- License
- PT27232 (CA)
- Practice address
- 47915 Oasis St
Indio, CA 92201-6950 - Phone
- (760) 863-8600
- NPI assigned
- Dec 29, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT27232 | CA | MD | Licensed Psychiatric Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | PT27232 | CA | Yes |
Addresses
Primary practice location
47915 Oasis St
Indio, CA 92201-6950
Mailing address
47915 Oasis St
Indio, CA 92201-6950
Phone (760) 863-8600
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- Tobias Moeller-Bertram MD Corporation
All providers in Indio, CA · Licensed Psychiatric Technician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.