Provider Demographics
NPI:1669732848
Name:THOMPSON, DENISE LYNN (LPC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:LYNN
Other - Last Name:BRANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:103 LIBERTY PLAZA
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-0000
Mailing Address - Country:US
Mailing Address - Phone:636-584-3629
Mailing Address - Fax:
Practice Address - Street 1:103 LIBERTY PLAZA
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-0000
Practice Address - Country:US
Practice Address - Phone:636-584-3629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010021553101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional