Provider Demographics
NPI:1629315163
Name:THOMSON, BRUCE H (LMSW)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:H
Last Name:THOMSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2682 WHITE OAK DRVIE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2361
Mailing Address - Country:US
Mailing Address - Phone:734-994-8120
Mailing Address - Fax:
Practice Address - Street 1:2682 WHITE OAK DRVIE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2361
Practice Address - Country:US
Practice Address - Phone:734-994-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010918261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical