Provider Demographics
NPI:1255685533
Name:THOMPSON, ROSE Y (NCPT3)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:Y
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NCPT3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5513 W CHEYENNE AVE
Mailing Address - Street 2:APT A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4740
Mailing Address - Country:US
Mailing Address - Phone:702-736-6320
Mailing Address - Fax:
Practice Address - Street 1:5513 W CHEYENNE AVE
Practice Address - Street 2:APT A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4740
Practice Address - Country:US
Practice Address - Phone:702-736-6320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANCPT3101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)