Provider Demographics
NPI:1609635606
Name:THOMPSON, TYLER SCOTT (LMFT, LPCC)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:SCOTT
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2206
Mailing Address - Country:US
Mailing Address - Phone:720-334-1637
Mailing Address - Fax:
Practice Address - Street 1:1416 EVERETT ST
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2206
Practice Address - Country:US
Practice Address - Phone:720-334-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124737106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist