Provider Demographics
NPI:1093169385
Name:THOMPSON, ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 W HIGHWAY 66 APT 107
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3239
Mailing Address - Country:US
Mailing Address - Phone:405-667-3149
Mailing Address - Fax:
Practice Address - Street 1:4010 N LINCOLN BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5220
Practice Address - Country:US
Practice Address - Phone:405-595-2435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator