Provider Demographics
NPI:1346450079
Name:THOMPSON, ELIZABETH ANN (MSW, RPT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSW, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 HANNAH AVE
Mailing Address - Street 2:STE C
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3399
Mailing Address - Country:US
Mailing Address - Phone:231-946-9740
Mailing Address - Fax:
Practice Address - Street 1:697 HANNAH AVE
Practice Address - Street 2:STE C
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3399
Practice Address - Country:US
Practice Address - Phone:231-946-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010773831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical