Provider Demographics
NPI:1083264105
Name:THOMPSON, LEAH NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:NICOLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 HAHNS PEAK DR UNIT 203
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-6169
Mailing Address - Country:US
Mailing Address - Phone:815-416-8774
Mailing Address - Fax:
Practice Address - Street 1:1318 S COLLEGE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-775-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0015640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional