Provider Demographics
NPI:1508603374
Name:THOMPSON, CLARA MARIA (PSYD)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:MARIA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 CRESTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-6351
Mailing Address - Country:US
Mailing Address - Phone:786-213-1612
Mailing Address - Fax:
Practice Address - Street 1:6004 CRESTVIEW CT
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-6351
Practice Address - Country:US
Practice Address - Phone:786-213-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical