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NPI Code Detail

MEDICARE: ELISA D THOMPSON

MEDICARE: ELISA D 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1902088685
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISA D THOMPSON
Provider Business Mailing Address
First Line : 7777 E US HIGHWAY 66
Second Line :
City : EL RENO
State : OK
Zip : 73036-9125
Country : US
Telephone Number : 405-422-8823
Fax Number : 405-632-1976
Provider Business Practice Location Address
First Line : 7777 E US HIGHWAY 66
Second Line :
City : EL RENO
State : OK
Zip : 73036-9125
Country : US
Telephone Number : 405-422-8823
Fax Number : 405-632-1976
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2007
Last Update Date : 11/10/2009

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Directions to “ ELISA D THOMPSON ” Practice Location

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