Provider Demographics
NPI:1265574255
Name:THOMPSON, CATHY TILLEY (CMSW)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:TILLEY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 MORNING LAKE DR APT 101
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-8498
Mailing Address - Country:US
Mailing Address - Phone:731-431-7973
Mailing Address - Fax:
Practice Address - Street 1:2890 BEKEMEYER DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-9522
Practice Address - Country:US
Practice Address - Phone:901-252-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW0000005160104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCSW0000005160OtherCMSW