Provider Demographics
NPI:1598349417
Name:THOMPSON, JE LISA MONIQUE (MED)
Entity Type:Individual
Prefix:
First Name:JE LISA
Middle Name:MONIQUE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9246 SPEERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0900
Mailing Address - Country:US
Mailing Address - Phone:901-756-1996
Mailing Address - Fax:
Practice Address - Street 1:9246 SPEERBERRY LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0900
Practice Address - Country:US
Practice Address - Phone:901-584-6539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health