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NPI Code Detail

MEDICARE: AMANDA THOMPSON

MEDICARE: AMANDA THOMPSON
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
1106H00000XMarriage & Family Therapist
2101YP2500XProfessional CounselorE.1100359OH

General Provider Information

NPI Number : 1629358858
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA THOMPSON
Provider Business Mailing Address
First Line : 420 W MAIN ST
Second Line :
City : KENT
State : OH
Zip : 44240-2208
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 420 W MAIN ST
Second Line :
City : KENT
State : OH
Zip : 44240-2208
Country : US
Telephone Number : 330-677-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2011
Last Update Date : 03/27/2018

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Directions to “ AMANDA THOMPSON ” Practice Location

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