Provider Demographics
NPI:1720166846
Name:THOMPSON, JAMES ALLEN (MS, LPC, CSAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALLEN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MS, LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 GISHOLT DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4816
Mailing Address - Country:US
Mailing Address - Phone:608-406-2624
Mailing Address - Fax:608-518-3062
Practice Address - Street 1:6000 GISHOLT DR STE 202
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-4816
Practice Address - Country:US
Practice Address - Phone:608-406-2624
Practice Address - Fax:608-518-3062
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11803101YA0400X
WI3090-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43588900Medicare ID - Type UnspecifiedCOUNSELOR