Provider Demographics
NPI:1053456418
Name:THOMPSON, LOIS JEAN (EDD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:JEAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:HEIDKE
Other - Last Name:ORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 ARAGON AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3505
Mailing Address - Country:US
Mailing Address - Phone:505-672-3050
Mailing Address - Fax:505-672-3050
Practice Address - Street 1:340 ARAGON AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3505
Practice Address - Country:US
Practice Address - Phone:505-672-3050
Practice Address - Fax:505-672-3050
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM391103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist