Provider Demographics
NPI:1417465394
Name:THOMPSON, MONICA (LPC- INTERN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC- INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142621
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75014-2621
Mailing Address - Country:US
Mailing Address - Phone:972-379-9105
Mailing Address - Fax:
Practice Address - Street 1:1910 PACIFIC AVE STE 15840
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4243
Practice Address - Country:US
Practice Address - Phone:972-379-9105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-13
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77850101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor