Provider Demographics
NPI:1891805818
Name:THOMPSON, NANCY S (PHD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4072 S TALAVERA WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5671
Mailing Address - Country:US
Mailing Address - Phone:208-841-1174
Mailing Address - Fax:
Practice Address - Street 1:3350 W AMERICANA TER STE 320
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2548
Practice Address - Country:US
Practice Address - Phone:208-841-1174
Practice Address - Fax:208-336-0333
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY202057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010143783OtherREGENCE BLUE SHIELD
IDN5533OtherBLUE CROSS
ID1684447Medicare ID - Type Unspecified