Provider Demographics
NPI:1306504618
Name:THOMPSON, BRYAN (MED, EDS)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-1736
Mailing Address - Country:US
Mailing Address - Phone:740-914-5000
Mailing Address - Fax:740-914-5005
Practice Address - Street 1:827 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-1736
Practice Address - Country:US
Practice Address - Phone:740-914-5000
Practice Address - Fax:740-914-5005
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 171M00000X, 101YM0800X
OHOH3153062103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty