Provider Demographics
NPI:1609948017
Name:THOMPSON, JOHN C (LPC-MHSP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 WEST BLYTHE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-3423
Mailing Address - Country:US
Mailing Address - Phone:731-642-9026
Mailing Address - Fax:731-642-1838
Practice Address - Street 1:204 WEST BLYTHE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-3423
Practice Address - Country:US
Practice Address - Phone:731-642-9026
Practice Address - Fax:731-642-1838
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC717101YM0800X
TNLPC0000000717101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507348Medicaid
TN3086882Medicare UPIN
TN1507348Medicaid