Provider Demographics
NPI:1598104770
Name:THOMPSON, NATHAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 E GUADALUPE RD
Mailing Address - Street 2:STE. 105B
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-9785
Mailing Address - Country:US
Mailing Address - Phone:480-331-9607
Mailing Address - Fax:480-656-7334
Practice Address - Street 1:1415 E GUADALUPE RD
Practice Address - Street 2:STE. 105B
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-9785
Practice Address - Country:US
Practice Address - Phone:480-331-9607
Practice Address - Fax:480-656-7334
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4404103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical