MEDICARE: MR. JAMES COLBY THOMPSON EDD

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	103TC0700X	Clinical Psychologist	128081	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000041742	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1710972807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES COLBY THOMPSON EDD

Provider Business Mailing Address
First Line	:	2400 EASTPOINT PKWY STE 410
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4154
Country	:	US
Telephone Number	:	502-253-6625
Fax Number	:	502-253-6629

Provider Business Practice Location Address
First Line	:	2400 EASTPOINT PKWY STE 410
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4154
Country	:	US
Telephone Number	:	502-253-6625
Fax Number	:	502-253-6629

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	09/07/2022

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