Provider Demographics
NPI:1851679823
Name:THOMPSON, ALEXA LYNN (LCPC)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CHAMPAGNE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1605
Mailing Address - Country:US
Mailing Address - Phone:573-680-2320
Mailing Address - Fax:
Practice Address - Street 1:22043 JORDAN LN
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-1269
Practice Address - Country:US
Practice Address - Phone:573-680-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011029171101YP2500X
IL180.012074101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional