Provider Demographics
NPI:1730663584
Name:THOMPSON, STEPHANIE MAKAYLA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MAKAYLA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15228 SAM GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-0602
Mailing Address - Country:US
Mailing Address - Phone:985-335-4141
Mailing Address - Fax:
Practice Address - Street 1:537 KENTUCKY AVE STE B
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3913
Practice Address - Country:US
Practice Address - Phone:985-241-5448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker