Provider Demographics
NPI:1437434578
Name:THOMSEN, AMY LARAINE
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:LARAINE
Last Name:THOMSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 NE 64TH LN UNIT 502
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6619
Mailing Address - Country:US
Mailing Address - Phone:619-519-0609
Mailing Address - Fax:
Practice Address - Street 1:3900 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2226
Practice Address - Country:US
Practice Address - Phone:503-359-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health