Provider Demographics
NPI:1902938913
Name:THOMPSON, MARGARET J (MFT)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:PEGGY
Other - Middle Name:BRYAN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:145 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-5951
Mailing Address - Country:US
Mailing Address - Phone:559-974-2062
Mailing Address - Fax:559-442-0207
Practice Address - Street 1:1502 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3723
Practice Address - Country:US
Practice Address - Phone:559-974-2062
Practice Address - Fax:559-442-0207
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34522106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARO220543OtherCA DRIVER'S LICENSE