Provider Demographics
NPI:1639909583
Name:THOMPSON, KATY ROXANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATY
Middle Name:ROXANE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:KATY
Other - Middle Name:ROXANE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 750
Mailing Address - Street 2:
Mailing Address - City:STINNETT
Mailing Address - State:TX
Mailing Address - Zip Code:79083-0750
Mailing Address - Country:US
Mailing Address - Phone:806-886-0178
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 750
Practice Address - Street 2:
Practice Address - City:STINNETT
Practice Address - State:TX
Practice Address - Zip Code:79083-0750
Practice Address - Country:US
Practice Address - Phone:806-886-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical