Provider Demographics
NPI:1497821045
Name:THOMPSON, GUY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:GERSHOM
Other - Middle Name:
Other - Last Name:TAUB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:6540 N CALIFORNIA
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4402
Mailing Address - Country:US
Mailing Address - Phone:773-743-9100
Mailing Address - Fax:
Practice Address - Street 1:6540 N CALIFORNIA
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-4402
Practice Address - Country:US
Practice Address - Phone:773-743-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001634493OtherBCBS PROVIDER