Provider Demographics
NPI:1609826767
Name:THOMPSON, KARMELLA J (MS, LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:KARMELLA
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1482
Mailing Address - Country:US
Mailing Address - Phone:218-631-1714
Mailing Address - Fax:218-631-4228
Practice Address - Street 1:11 2ND ST SW
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1482
Practice Address - Country:US
Practice Address - Phone:218-631-1714
Practice Address - Fax:218-631-4228
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300625101YA0400X
MN3399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)