Provider Demographics
NPI:1225665284
Name:THOMPSON, MCKINLEY A
Entity Type:Individual
Prefix:
First Name:MCKINLEY
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5157 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-5708
Mailing Address - Country:US
Mailing Address - Phone:408-391-2926
Mailing Address - Fax:
Practice Address - Street 1:5157 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-5708
Practice Address - Country:US
Practice Address - Phone:408-391-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty