Provider Demographics
NPI:1518460823
Name:THOMPSON, TERI (LCPC)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:TERI
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:1061 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-2021
Mailing Address - Country:US
Mailing Address - Phone:708-745-1809
Mailing Address - Fax:
Practice Address - Street 1:15300 WEST AVE STE 313
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4687
Practice Address - Country:US
Practice Address - Phone:708-460-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health