Provider Demographics
NPI:1609945062
Name:THOMPSON, MARY R (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 KILGOUR ST
Mailing Address - Street 2:
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1363
Mailing Address - Country:US
Mailing Address - Phone:989-635-2168
Mailing Address - Fax:
Practice Address - Street 1:217 E. SANILAC
Practice Address - Street 2:SUITE ONE
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471
Practice Address - Country:US
Practice Address - Phone:810-648-4450
Practice Address - Fax:810-648-5833
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010596811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical