MEDICARE: MONIQUE MICHELLE 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	101YM0800X	Mental Health Counselor	17013	TX

General Provider Information

NPI Number	:	1629182274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE MICHELLE THOMPSON LPC

Provider Business Mailing Address
First Line	:	4100 MCEWEN RD
Second Line	:	SUITE 285
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-5113
Country	:	US
Telephone Number	:	972-820-9965
Fax Number	:	866-278-4727

Provider Business Practice Location Address
First Line	:	4100 MCEWEN RD
Second Line	:	SUITE 285
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-5113
Country	:	US
Telephone Number	:	972-820-9965
Fax Number	:	866-278-4727

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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