Provider Demographics
NPI:1821172115
Name:THOMPSON, HEIDI MARIE (PHD LICENSED PSYCHOL)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD LICENSED PSYCHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 SALEM RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6159
Mailing Address - Country:US
Mailing Address - Phone:501-733-0829
Mailing Address - Fax:501-358-4368
Practice Address - Street 1:306 SALEM RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6159
Practice Address - Country:US
Practice Address - Phone:501-733-0829
Practice Address - Fax:501-358-4368
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0511P103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y258Medicare ID - Type Unspecified