Provider Demographics
NPI:1821310061
Name:THOMPSON, BRIAN LANTZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LANTZ
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 NE GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3912
Mailing Address - Country:US
Mailing Address - Phone:503-281-4852
Mailing Address - Fax:503-281-4852
Practice Address - Street 1:1830 NE GRAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3912
Practice Address - Country:US
Practice Address - Phone:503-281-4852
Practice Address - Fax:503-281-4852
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist