Provider Demographics
NPI:1700168358
Name:THOMPSON, JUAN MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MICHAEL
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4087 HIGHWAY 31 SW
Mailing Address - Street 2:
Mailing Address - City:FALKVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35622-6319
Mailing Address - Country:US
Mailing Address - Phone:256-466-1546
Mailing Address - Fax:
Practice Address - Street 1:4087 HIGHWAY 31 SW
Practice Address - Street 2:
Practice Address - City:FALKVILLE
Practice Address - State:AL
Practice Address - Zip Code:35622-6319
Practice Address - Country:US
Practice Address - Phone:256-466-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1701103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling