Provider Demographics
NPI:1568762946
Name:THOMPSON, ELISABETH
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 N MACARTHUR BLVD
Mailing Address - Street 2:2714
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-3032
Mailing Address - Country:US
Mailing Address - Phone:405-650-4963
Mailing Address - Fax:
Practice Address - Street 1:6613 N MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1423
Practice Address - Country:US
Practice Address - Phone:405-603-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist