Provider Demographics
NPI:1831728385
Name:THOMPSON, LYNETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 N BANNER RD
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-9110
Mailing Address - Country:US
Mailing Address - Phone:405-422-6327
Mailing Address - Fax:
Practice Address - Street 1:1707 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6470
Practice Address - Country:US
Practice Address - Phone:405-422-6327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty