Provider Demographics
NPI:1164733994
Name:THOMPSON, MICHAEL S (MFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 N 490 W
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2264
Mailing Address - Country:US
Mailing Address - Phone:801-763-7775
Mailing Address - Fax:801-763-7651
Practice Address - Street 1:71 N 490 W
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2264
Practice Address - Country:US
Practice Address - Phone:801-763-7775
Practice Address - Fax:801-763-7651
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-26
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6212908-3904101YP2500X
UT6212908-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional