MEDICARE: DENISE LYNN 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	2010021553	MO

General Provider Information

NPI Number	:	1669732848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE LYNN THOMPSON LPC

Provider Business Mailing Address
First Line	:	103 LIBERTY PLAZA
Second Line	:
City	:	UNION
State	:	MO
Zip	:	63084-0000
Country	:	US
Telephone Number	:	636-584-3629
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 LIBERTY PLAZA
Second Line	:
City	:	UNION
State	:	MO
Zip	:	63084-0000
Country	:	US
Telephone Number	:	636-584-3629
Fax Number	:

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

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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