Provider Demographics
NPI:1942212535
Name:THOMPSON, SHELLY LYNN
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6018 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-5042
Mailing Address - Country:US
Mailing Address - Phone:806-791-4809
Mailing Address - Fax:
Practice Address - Street 1:5121 69TH ST STE B711
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1645
Practice Address - Country:US
Practice Address - Phone:806-798-3000
Practice Address - Fax:806-798-3005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7317LCOtherBCBS