Provider Demographics
NPI:1740965854
Name:THOMPSON, JOSEPH CHRISTIAN (LLC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CHRISTIAN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 WINCHESTER DR APT 209
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3260
Mailing Address - Country:US
Mailing Address - Phone:231-327-3720
Mailing Address - Fax:
Practice Address - Street 1:516 E COLBY ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1113
Practice Address - Country:US
Practice Address - Phone:231-893-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health