Provider Demographics
NPI:1134491293
Name:CUESTAS -THOMPSON INCORPORATED
Entity Type:Organization
Organization Name:CUESTAS -THOMPSON INCORPORATED
Other - Org Name:ERIC CUESTAS-THOMPSON, LCSW, LISAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CUESTAS-THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LCSW, LISAC
Authorized Official - Phone:253-348-2242
Mailing Address - Street 1:1019 29TH STREET PL NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-3519
Mailing Address - Country:US
Mailing Address - Phone:253-348-2242
Mailing Address - Fax:253-697-9938
Practice Address - Street 1:748 MARKET ST STE 80
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3737
Practice Address - Country:US
Practice Address - Phone:253-348-2242
Practice Address - Fax:253-697-9938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
AZ12502251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2044698Medicaid