Provider Demographics
NPI:1245445279
Name:THOMPSON, DANIEL J
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28247 AXIS DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5119
Mailing Address - Country:US
Mailing Address - Phone:830-981-8081
Mailing Address - Fax:830-755-9016
Practice Address - Street 1:8600 WURZBACH RD
Practice Address - Street 2:SUITE 1103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4330
Practice Address - Country:US
Practice Address - Phone:210-822-5971
Practice Address - Fax:210-614-0691
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21198103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00LL65Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST