1265514806 NPI number — MRS. HEATHER THOMPSON MARSHALL LMFT

Table of content: MRS. HEATHER THOMPSON MARSHALL LMFT (NPI 1265514806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265514806 NPI number — MRS. HEATHER THOMPSON MARSHALL LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSHALL
Provider First Name:
HEATHER
Provider Middle Name:
THOMPSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
HEATHER
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
IMF
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265514806
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 N MCKINNEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWEENY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77480-2801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-548-1550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 N MCKINNEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWEENY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77480-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-548-1550
Provider Business Practice Location Address Fax Number:
979-548-3105
Provider Enumeration Date:
10/20/2006

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: 106H00000X , with the licence number:  201476 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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