1740659606 NPI number — AMBER RAYBORN THOMPSON LCSW

Table of content: AMBER RAYBORN THOMPSON LCSW (NPI 1740659606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740659606 NPI number — AMBER RAYBORN THOMPSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
AMBER
Provider Middle Name:
RAYBORN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
AMBER
Provider Other Middle Name:
LANIKA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740659606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2585 BRIGHTSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70820-3504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-665-7878
Provider Business Mailing Address Fax Number:
225-665-7856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2585 BRIGHTSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70820-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-715-5065
Provider Business Practice Location Address Fax Number:
225-715-5065
Provider Enumeration Date:
09/22/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)