Provider Demographics
NPI:1558095943
Name:THOMPSON, TERRY ELAINE (LICENSE VOCATIONAL N)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:ELAINE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LICENSE VOCATIONAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 ROMANWAY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75249-2611
Mailing Address - Country:US
Mailing Address - Phone:469-865-8554
Mailing Address - Fax:
Practice Address - Street 1:8417 ROMANWAY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75249-2611
Practice Address - Country:US
Practice Address - Phone:469-865-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87719171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach