Provider Demographics
NPI:1265684377
Name:THOMPSON, MICHAEL STEVEN (BS, LLB, MA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:BS, LLB, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 E BERNADETTE ROAD
Mailing Address - Street 2:
Mailing Address - City:MOHAVE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86440-8816
Mailing Address - Country:US
Mailing Address - Phone:928-768-2265
Mailing Address - Fax:
Practice Address - Street 1:3213 E BERNADETTE ROAD
Practice Address - Street 2:
Practice Address - City:MOHAVE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86440-8816
Practice Address - Country:US
Practice Address - Phone:928-768-2265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health