Provider Demographics
NPI:1518309095
Name:THOMPSON, SILAS T (LCSW)
Entity Type:Individual
Prefix:
First Name:SILAS
Middle Name:T
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7167 1ST ST UNIT 465
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-2321
Mailing Address - Country:US
Mailing Address - Phone:208-290-4944
Mailing Address - Fax:
Practice Address - Street 1:7167 1ST ST UNIT 465
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-2321
Practice Address - Country:US
Practice Address - Phone:208-290-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-352161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLMSW-33059OtherIDAHO STATE