Provider Demographics
NPI:1124207626
Name:THOMPSON, TERAH L (LMSW)
Entity Type:Individual
Prefix:
First Name:TERAH
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:BUCKLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67834-0433
Mailing Address - Country:US
Mailing Address - Phone:913-669-9795
Mailing Address - Fax:
Practice Address - Street 1:610 E GRANT AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KS
Practice Address - Zip Code:67054-2708
Practice Address - Country:US
Practice Address - Phone:913-669-9795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5935104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker