Provider Demographics
NPI:1710972807
Name:THOMPSON, JAMES COLBY (EDD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:COLBY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 EASTPOINT PKWY STE 410
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4154
Mailing Address - Country:US
Mailing Address - Phone:502-253-6625
Mailing Address - Fax:502-253-6629
Practice Address - Street 1:2400 EASTPOINT PKWY STE 410
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4154
Practice Address - Country:US
Practice Address - Phone:502-253-6625
Practice Address - Fax:502-253-6629
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY128081103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY89007660Medicaid
KY000000041742OtherANTHEM
C73386Medicare UPIN
KY0394502Medicare ID - Type Unspecified