Provider Demographics
NPI:1548425135
Name:THOMPSON, MICHAEL SUNG IL (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SUNG IL
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 BOONE AVE N STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1089
Mailing Address - Country:US
Mailing Address - Phone:763-515-2463
Mailing Address - Fax:763-515-2442
Practice Address - Street 1:7600 BOONE AVE N STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1089
Practice Address - Country:US
Practice Address - Phone:763-515-2463
Practice Address - Fax:763-515-2442
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health