Provider Demographics
NPI:1437886785
Name:THOMPSON, PRISCILLA JEAN
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:JEAN
Last Name:THOMPSON
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 1:240 GREAT CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1707
Mailing Address - Country:US
Mailing Address - Phone:615-331-1141
Mailing Address - Fax:
Practice Address - Street 1:162 SYCAMORE HILL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-1779
Practice Address - Country:US
Practice Address - Phone:516-993-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRBT-20-149078106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician