Provider Demographics
NPI:1235610445
Name:THOMPSON THERAPY LLC
Entity Type:Organization
Organization Name:THOMPSON THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, PHD
Authorized Official - Phone:385-312-0440
Mailing Address - Street 1:1675 N FREEDOM BLVD STE 2B2
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2540
Mailing Address - Country:US
Mailing Address - Phone:385-312-0440
Mailing Address - Fax:
Practice Address - Street 1:1675 N FREEDOM BLVD STE 2B2
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2540
Practice Address - Country:US
Practice Address - Phone:385-312-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9151068-0160261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)