Provider Demographics
NPI:1467965418
Name:THOMPSON, JEFFREY WILLIAM (MSW CSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MSW CSW
Other - Prefix:MR
Other - First Name:JEFFREY
Other - Middle Name:WILLIAM
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW CSW
Mailing Address - Street 1:167 LEOTA BLVD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-3631
Mailing Address - Country:US
Mailing Address - Phone:248-310-7081
Mailing Address - Fax:
Practice Address - Street 1:167 LEOTA BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-3631
Practice Address - Country:US
Practice Address - Phone:248-310-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801063750103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent