Provider Demographics
NPI:1336669027
Name:THOMPSON, JO MARIA (CBHT)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:MARIA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CBHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 SW 22ND TER
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2249
Mailing Address - Country:US
Mailing Address - Phone:786-985-0663
Mailing Address - Fax:314-237-4923
Practice Address - Street 1:7947 JOHNSON ST APT 11
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6847
Practice Address - Country:US
Practice Address - Phone:954-549-3547
Practice Address - Fax:314-237-4923
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL826106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician