Provider Demographics
NPI:1831261163
Name:THOMPSON, PARKER L (LCSW)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DUNLAP ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4131
Mailing Address - Country:US
Mailing Address - Phone:731-407-4410
Mailing Address - Fax:
Practice Address - Street 1:400 DUNLAP ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4131
Practice Address - Country:US
Practice Address - Phone:731-407-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000034381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN270807Medicare UPIN
TN148922Medicare UPIN
TN103I801991Medicare PIN
TN4115551Medicare UPIN
TN3697555Medicare ID - Type UnspecifiedMEDICARE ID