Provider Demographics
NPI:1245236686
Name:THOMSON, RICHARD ANTHONY (MSW, LMSW, ACSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:THOMSON
Suffix:
Gender:M
Credentials:MSW, LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-8601
Mailing Address - Country:US
Mailing Address - Phone:989-529-2627
Mailing Address - Fax:989-895-6222
Practice Address - Street 1:660 W CENTER RD
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-2030
Practice Address - Country:US
Practice Address - Phone:989-529-2627
Practice Address - Fax:989-895-6222
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010672431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N93380Medicare ID - Type Unspecified