Provider Demographics
NPI:1679899090
Name:THOMPSON, PENNY L (BA BHRS)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BA BHRS
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 5
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:OK
Mailing Address - Zip Code:73095-0005
Mailing Address - Country:US
Mailing Address - Phone:405-425-9551
Mailing Address - Fax:
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1307
Practice Address - Country:US
Practice Address - Phone:405-425-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor