Provider Demographics
NPI:1457631921
Name:THOMPSON, JASON RANCE (LPC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:RANCE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SOUTH BLVD W
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5184
Mailing Address - Country:US
Mailing Address - Phone:248-852-8658
Mailing Address - Fax:
Practice Address - Street 1:110 SOUTH BLVD W
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5184
Practice Address - Country:US
Practice Address - Phone:248-852-8658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional