MEDICARE: FREDERICK D THOMPSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2011036959	MO

General Provider Information

NPI Number	:	1194062968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK D THOMPSON LPC

Provider Business Mailing Address
First Line	:	14 GREENWAY CIR
Second Line	:
City	:	FAIRLESS HILLS
State	:	PA
Zip	:	19030-4013
Country	:	US
Telephone Number	:	573-673-9724
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 GREENWAY CIR
Second Line	:
City	:	FAIRLESS HILLS
State	:	PA
Zip	:	19030-4013
Country	:	US
Telephone Number	:	573-673-9724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2013
Last Update Date	:	01/13/2013

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