Provider Demographics
NPI:1841663960
Name:WESLEY THOMPSON PSYD LLC
Entity type:Organization
Organization Name:WESLEY THOMPSON PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:573-446-6290
Mailing Address - Street 1:2804 FORUM BLVD
Mailing Address - Street 2:STE 3A
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2804 FORUM BLVD
Practice Address - Street 2:STE 3A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6322
Practice Address - Country:US
Practice Address - Phone:573-446-6290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014031972103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty