Provider Demographics
NPI:1649003823
Name:THOMPSON, MARYSS ASHLEIGH
Entity type:Individual
Prefix:MS
First Name:MARYSS
Middle Name:ASHLEIGH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31611 29 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MI
Mailing Address - Zip Code:48050-2334
Mailing Address - Country:US
Mailing Address - Phone:586-914-1337
Mailing Address - Fax:
Practice Address - Street 1:1460 WALTON BLVD STE 60
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1729
Practice Address - Country:US
Practice Address - Phone:248-608-4514
Practice Address - Fax:248-608-4519
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor