Provider Demographics
NPI:1710688155
Name:THOMPSON, GRIEAY LASHON (MPSS)
Entity Type:Individual
Prefix:
First Name:GRIEAY
Middle Name:LASHON
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MPSS
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 561323
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-0207
Mailing Address - Country:US
Mailing Address - Phone:323-306-8120
Mailing Address - Fax:323-544-0890
Practice Address - Street 1:6317 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-1025
Practice Address - Country:US
Practice Address - Phone:323-301-8120
Practice Address - Fax:323-544-0890
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-SDKJCW175T00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist