Provider Demographics
NPI:1497154918
Name:THOMPSON, LISA AIMEE (LPC,CRC,PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:AIMEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC,CRC,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N EAST AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5226
Mailing Address - Country:US
Mailing Address - Phone:479-935-5430
Mailing Address - Fax:
Practice Address - Street 1:221 N EAST AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5226
Practice Address - Country:US
Practice Address - Phone:479-935-5430
Practice Address - Fax:877-355-8230
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1605056101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional