Provider Demographics
NPI:1568086080
Name:JESSICA THOMPSON, LCSW, LLC
Entity Type:Organization
Organization Name:JESSICA THOMPSON, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:903-780-1513
Mailing Address - Street 1:3300 S BROADWAY AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7818
Mailing Address - Country:US
Mailing Address - Phone:903-780-1513
Mailing Address - Fax:903-200-2013
Practice Address - Street 1:3300 S BROADWAY AVE STE 212
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7818
Practice Address - Country:US
Practice Address - Phone:903-780-1513
Practice Address - Fax:903-200-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty