Provider Demographics
NPI:1679744916
Name:THOMPSON, PAUL (LLP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 ROBERT T LONGWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-1851
Mailing Address - Country:US
Mailing Address - Phone:810-232-8466
Mailing Address - Fax:810-232-0041
Practice Address - Street 1:1172 ROBERT T LONGWAY BLVD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1851
Practice Address - Country:US
Practice Address - Phone:810-232-8466
Practice Address - Fax:810-232-0041
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301004001103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist