Provider Demographics
NPI:1770310716
Name:THOMPSON, MALLORI S (LPC-A)
Entity type:Individual
Prefix:MRS
First Name:MALLORI
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:MRS
Other - First Name:MALLORI
Other - Middle Name:S
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4304 JOHNSTOWN LN
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3259
Mailing Address - Country:US
Mailing Address - Phone:469-250-0611
Mailing Address - Fax:
Practice Address - Street 1:4304 JOHNSTOWN LN
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75126-3259
Practice Address - Country:US
Practice Address - Phone:469-250-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health