Provider Demographics
NPI:1750065629
Name:THOMPSON, PHOEBE (LPC)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 WOODCREST MANOR CT APT A
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8492
Mailing Address - Country:US
Mailing Address - Phone:314-920-2981
Mailing Address - Fax:
Practice Address - Street 1:12801 FLUSHING MEADOWS DR STE 110
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1829
Practice Address - Country:US
Practice Address - Phone:314-907-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020034576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health