Provider Demographics
NPI:1033430574
Name:THOMPSON, PATRICA LOU (MED)
Entity Type:Individual
Prefix:MS
First Name:PATRICA
Middle Name:LOU
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 N CLARENCE NASH BLVD
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-3636
Mailing Address - Country:US
Mailing Address - Phone:580-623-5433
Mailing Address - Fax:
Practice Address - Street 1:403 N CLARENCE NASH BLVD
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-3636
Practice Address - Country:US
Practice Address - Phone:580-623-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional