Provider Demographics
NPI:1295348852
Name:THOMPSON, ELIZABETH (MS)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 SPRING VALLEY RD STE 520
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3629
Mailing Address - Country:US
Mailing Address - Phone:469-340-1116
Mailing Address - Fax:844-496-1266
Practice Address - Street 1:4100 SPRING VALLEY RD STE 520
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3629
Practice Address - Country:US
Practice Address - Phone:469-340-1116
Practice Address - Fax:844-496-1266
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional