1578551289 NPI number — MS. ELISSA EILEEN THOMPSON MSW, LCSW

Table of content: MS. ELISSA EILEEN THOMPSON MSW, LCSW (NPI 1578551289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578551289 NPI number — MS. ELISSA EILEEN THOMPSON MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
ELISSA
Provider Middle Name:
EILEEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578551289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8253 W THUNDERBIRD RD
Provider Second Line Business Mailing Address:
103
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85381-4616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-881-0556
Provider Business Mailing Address Fax Number:
623-776-9921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8253 W THUNDERBIRD RD
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85381-4616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-881-0556
Provider Business Practice Location Address Fax Number:
623-776-9921
Provider Enumeration Date:
10/07/2005

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: 1041C0700X , with the licence number:  LCSW 10384 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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