Provider Demographics
NPI:1306836341
Name:THOMPSON, PAUL MERRELL (LPC (DMIN))
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MERRELL
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LPC (DMIN)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 WINTHROP AVE
Mailing Address - Street 2:SUITE 100 B
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5614
Mailing Address - Country:US
Mailing Address - Phone:817-796-5889
Mailing Address - Fax:817-585-4834
Practice Address - Street 1:3309 WINTHROP AVE
Practice Address - Street 2:SUITE 100 B
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5614
Practice Address - Country:US
Practice Address - Phone:817-796-5889
Practice Address - Fax:817-585-4834
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14628101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028101602Medicaid