CLEVELAND ANTHONY THIBODEAUX III (NPI# 1740800531) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740800531 |
| Entity Type | Individual |
| Full Name | CLEVELAND ANTHONY THIBODEAUX III |
| Practice Address |
2101 Courage Dr Fairfield CA 94533-6717 |
| Mailing Address |
1966 Finch Way Fairfield CA 94533-2312 |
| Practice Telephone | 7074281131 |
| Mailing Telephone | 7073891563 |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2020-04-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| Street Address |
2101 COURAGE DR |
| City | FAIRFIELD |
| State | CA |
| Zip Code | 94533-6717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396736732 | Sarah Jane Bolger | Nurse Practitioner | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2005-11-03 |
| 1235754706 | Armina Roseanna Delacruz | Counselor | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-06-10 |
| 1043834955 | Rodney Ralls | Counselor | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-06-05 |
| 1477173672 | Lauren Elayna Lopez | Case Manager/Care Coordinator | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-04-17 |
| 1497388763 | Edward Lusung Mendoza | Licensed Vocational Nurse | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-02-14 |
| 1598397655 | Pamela Monterrosa | Student in an Organized Health Care Education/Training Program | 2101 Courage Dr, Fairfield, CA 94533 | 2020-02-06 |
| 1205476801 | Lemuel Francis Constantino | Registered Nurse | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-01-10 |
| 1285273490 | Simone Lenore Adkins | Counselor | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-01-06 |
| 1376182857 | Sean Michael Maher | Registered Nurse | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2019-12-31 |
| 1093350530 | Jennifer Nicole Binion | Licensed Vocational Nurse | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2019-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609487347 | Shayondelice Sledge | Case Manager/Care Coordinator | 3001 N. Texas St., #27, Fairfield, CA 94533 | 2020-08-16 |
| 1508401191 | Tiffany Ann Garcia | Social Worker | 1301 Roman Way, Martinez, CA 94533 | 2019-11-07 |
| 1609424175 | Andrew Stephens | Student in an Organized Health Care Education/Training Program | Dgmc, 101 Bodin Cir, Fairfield, CA 94533 | 2019-08-28 |
| 1821645383 | Michelle Marie Hackett | Marriage & Family Therapist | 1745 Enterprise Dr., Bldg. 2, Ste 1a, Fairfield, CA 94533 | 2019-08-20 |
| 1780154369 | Maria Leonila Ramos Corpuz | Behavior Technician | 744 Empire Street Suite 160, Fairfield, CA 94533 | 2018-11-27 |
| 1629575303 | Jeanne Ann Kiernan | Dentist | 690 Airman Dr, Apo, AA 94533 | 2018-04-10 |
| 1629596820 | Max Kardos | Student in an Organized Health Care Education/Training Program | 801 Empire St., Fairfield, CA 94533 | 2017-09-07 |
| 1780119867 | Justin Denhart Dickson | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir Fairfield Ca 94533, David Grant Medical Center, Fpo, AA 94533 | 2017-04-26 |
| 1639613409 | Behrooz Shafiezadeh | Marriage & Family Therapist | Caminar, 601 Madison Street, Suite D, Fairfield, CA 94533 | 2016-12-13 |
| 1427500164 | Tanya Ayers | Counselor | 801 Empire Street, Fairfield, CA 94533 | 2016-10-28 |
| Find all providers in zip 94533 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629675624 | Natasha A Ridosh | Counselor | 2750 N Texas St Unit 7206, Fairfield, CA 94533-1176 | 2020-10-03 |
| 1003424219 | Amanda Kate Tubb | Counselor | 1601 Union Ave Apt 2, Fairfield, CA 94533-3731 | 2020-07-14 |
| 1447877964 | Victoria Larrieu Sebourne | Counselor | 35 Montauk St, Fairfield, CT 06825-1606 | 2020-06-30 |
| 1851913305 | Christian Vazquez | Counselor | 5114 Bickford Cir, Fairfield, CA 94533-6574 | 2020-05-07 |
| 1952923492 | Lionesha Nashell Lewis | Counselor | 701 E Travis Blvd Apt 13, Fairfield, CA 94533-8754 | 2020-05-07 |
| 1922629971 | Juan Carlos Cardenas | Counselor | 877 Sunset Ct, Fairfield, CA 94533-4145 | 2020-04-30 |
| 1518587013 | Jaime Quesada | Counselor | 1357 Astoria Dr, Fairfield, CA 94534-4325 | 2020-04-24 |
| 1871113316 | Scott D Wagner I | Counselor | 319 E Tabor Ave Apt 15319, Fairfield, CA 94533-3955 | 2020-04-24 |
| 1871113597 | Krystal Hill | Counselor | 2999 N Texas St Apt 23, Fairfield, CA 94533-1283 | 2020-04-22 |
| 1922561232 | Johnece M Smith | Counselor | 5010 Gary Ave, Fairfield, AL 35064-1349 | 2019-04-12 |
| Find all providers in FAIRFIELD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.