Provider Demographics
NPI:1043947922
Name:THOMPSON, MICHELLE (LAC, CMTPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LAC, CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 COGGINS DR APT B221
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4572
Mailing Address - Country:US
Mailing Address - Phone:860-280-6779
Mailing Address - Fax:
Practice Address - Street 1:870 MARKET ST STE 883
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2910
Practice Address - Country:US
Practice Address - Phone:415-362-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
CA19510171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist