Provider Demographics
NPI:1649588781
Name:THOMPSON-LOY, THERESA (MS)
Entity Type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:
Last Name:THOMPSON-LOY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1017
Mailing Address - Street 2:1502 E FAYETTE AVE
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1017
Mailing Address - Country:US
Mailing Address - Phone:217-857-1458
Mailing Address - Fax:217-857-1481
Practice Address - Street 1:1502 E FAYETTE AVE
Practice Address - Street 2:1502 E FAYETTE AVE
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1017
Practice Address - Country:US
Practice Address - Phone:217-857-1458
Practice Address - Fax:217-857-1481
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)