Provider Demographics
NPI:1336428168
Name:THOMPSON, PATRICIA (LPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LONGMONT ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-2927
Mailing Address - Country:US
Mailing Address - Phone:307-686-0669
Mailing Address - Fax:307-686-2121
Practice Address - Street 1:700 LONGMONT ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-2927
Practice Address - Country:US
Practice Address - Phone:307-686-0669
Practice Address - Fax:307-686-2121
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1336393834Medicaid