Provider Demographics
NPI:1295819845
Name:THOMPSON, NANCY B (RN MSW LCSW LMPT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:B
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN MSW LCSW LMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W LUCAS
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706
Mailing Address - Country:US
Mailing Address - Phone:409-898-3842
Mailing Address - Fax:
Practice Address - Street 1:3560 DELAWARE
Practice Address - Street 2:SUITE 104
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706
Practice Address - Country:US
Practice Address - Phone:409-899-2860
Practice Address - Fax:409-899-4235
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01415104100000X
TX002012 038425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00524NOtherBCBS