Provider Demographics
NPI:1649748062
Name:THOMPSON, KASSANDRA GRACE (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:GRACE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 KOTHMANN RD
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-5208
Mailing Address - Country:US
Mailing Address - Phone:210-847-0654
Mailing Address - Fax:
Practice Address - Street 1:32496 US HIGHWAY 281 N LOT B
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3233
Practice Address - Country:US
Practice Address - Phone:830-624-6846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-03
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78945101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional