Provider Demographics
NPI:1679864680
Name:THOMPSON, EDEN CHASE (CASE MANAGER II)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:CHASE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:CASE MANAGER II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 NW CACHE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5258
Mailing Address - Country:US
Mailing Address - Phone:580-351-9998
Mailing Address - Fax:
Practice Address - Street 1:2215 NW CACHE RD STE 107
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5258
Practice Address - Country:US
Practice Address - Phone:580-351-9998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator