Provider Demographics
NPI:1225131873
Name:THOMPSON, DEBRA R (LPCC, LPAT, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPCC, LPAT, ATR-BC
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:R
Other - Last Name:THOMPSON-MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3224 1/2 AVE DE SAN MARCOS
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-9250
Mailing Address - Country:US
Mailing Address - Phone:505-474-9358
Mailing Address - Fax:
Practice Address - Street 1:3224 1/2 AVE. DE SAN MARCOS
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-9250
Practice Address - Country:US
Practice Address - Phone:505-474-9358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6067101Y00000X
NM1180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00074984Medicaid