Provider Demographics
NPI:1033654439
Name:BRENDA T. THOMPSON
Entity Type:Organization
Organization Name:BRENDA T. THOMPSON
Other - Org Name:EM BRANCH & ASSOCIATES,
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:T
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-238-1100
Mailing Address - Street 1:11111 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3907
Mailing Address - Country:US
Mailing Address - Phone:773-238-1100
Mailing Address - Fax:
Practice Address - Street 1:11111 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3907
Practice Address - Country:US
Practice Address - Phone:773-238-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EM BRANCH & ASSOCIATES,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0022251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty