MEDICARE: MRS. MALLORI S THOMPSON LPC-A

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	93881	TX

General Provider Information

NPI Number	:	1770310716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MALLORI S THOMPSON LPC-A

Provider Business Mailing Address
First Line	:	4304 JOHNSTOWN LN
Second Line	:
City	:	HEATH
State	:	TX
Zip	:	75126-3259
Country	:	US
Telephone Number	:	469-250-0611
Fax Number	:

Provider Business Practice Location Address
First Line	:	4304 JOHNSTOWN LN
Second Line	:
City	:	HEATH
State	:	TX
Zip	:	75126-3259
Country	:	US
Telephone Number	:	469-250-0611
Fax Number	:

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

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/16/2024

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Directions to “ MRS. MALLORI S THOMPSON LPC-A” Practice Location

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