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NPI Code Detail

MEDICARE: KELLY RENEE THOMPSON LPC-A

MEDICARE: KELLY RENEE THOMPSON LPC-A
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
1101YP2500XProfessional Counselor90413TX

General Provider Information

NPI Number : 1275243503
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY RENEE THOMPSON LPC-A
Provider Business Mailing Address
First Line : 102 ALDEN VILLAGE CT
Second Line :
City : CARY
State : NC
Zip : 27519-9793
Country : US
Telephone Number : 214-403-3681
Fax Number :
Provider Business Practice Location Address
First Line : 3900 S STONEBRIDGE DR STE 604
Second Line :
City : MCKINNEY
State : TX
Zip : 75070-8051
Country : US
Telephone Number : 469-946-8255
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2022
Last Update Date : 11/28/2022

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