Provider Demographics
NPI:1235205394
Name:THOMPSON, MATTHEW J (BA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 PEARL ST APT 108
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2593
Mailing Address - Country:US
Mailing Address - Phone:970-371-6117
Mailing Address - Fax:303-831-4604
Practice Address - Street 1:1555 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1614
Practice Address - Country:US
Practice Address - Phone:303-504-1600
Practice Address - Fax:303-831-4604
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker