Provider Demographics
NPI:1629101944
Name:THOMPSON, PAUL JEFFREY (MA LPC, LBSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JEFFREY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MA LPC, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2333 MARLETTE RD.
Mailing Address - Street 2:
Mailing Address - City:APPLEGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48401-9739
Mailing Address - Country:US
Mailing Address - Phone:810-404-8524
Mailing Address - Fax:888-828-8290
Practice Address - Street 1:217 E SANILAC RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1383
Practice Address - Country:US
Practice Address - Phone:810-583-0452
Practice Address - Fax:810-648-0315
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009076101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor