Provider Demographics
NPI:1740713791
Name:THOMPSON, TONI
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
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 1:2608 HWY 528
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:LA
Mailing Address - Zip Code:71067
Mailing Address - Country:US
Mailing Address - Phone:318-716-1717
Mailing Address - Fax:318-716-1793
Practice Address - Street 1:4021 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-6422
Practice Address - Country:US
Practice Address - Phone:318-716-1717
Practice Address - Fax:318-716-1793
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health