Provider Demographics
NPI:1164980652
Name:THOMPSON, LYDIA GRACE (LPC-MHSP (TEMP))
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:GRACE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC-MHSP (TEMP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5908A CARL PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1945
Mailing Address - Country:US
Mailing Address - Phone:615-364-0434
Mailing Address - Fax:
Practice Address - Street 1:301 MALLORY STATION RD STE 110
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2825
Practice Address - Country:US
Practice Address - Phone:615-988-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health