MEDICARE: MR. PAUL EDWARD THOMPSON M.S., 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	101YM0800X	Mental Health Counselor	11488	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5360LC	OTHER	TX	BLUE CROSS & BLUE SHIELD
2	101407614	OTHER	TX	UNITED BEHAVIORAL HEALTH
3	4345207	OTHER	TX	AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1598810962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL EDWARD THOMPSON M.S., LPC

Provider Business Mailing Address
First Line	:	5751 KROGER DR.
Second Line	:	STE. 269
City	:	KELLER
State	:	TX
Zip	:	76244-5651
Country	:	US
Telephone Number	:	817-812-2880
Fax Number	:	817-812-3096

Provider Business Practice Location Address
First Line	:	5751 KROGER DR.
Second Line	:	STE. 269
City	:	KELLER
State	:	TX
Zip	:	76244-5651
Country	:	US
Telephone Number	:	817-812-2880
Fax Number	:	817-812-3096

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	05/22/2013

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