Provider Demographics
NPI:1427206580
Name:THOMPSON, ELEANOR KELSEY MARTIN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:KELSEY MARTIN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:KELSEY
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1287 MARKS CHURCH RD STE E2
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6330
Mailing Address - Country:US
Mailing Address - Phone:706-426-1913
Mailing Address - Fax:
Practice Address - Street 1:1287 MARKS CHURCH RD STE E2
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6330
Practice Address - Country:US
Practice Address - Phone:706-426-1913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001513106H00000X
GAAMFT000220106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC121328Medicaid
SC3335Medicare PIN