Healthcare Provider Details

I. General information

NPI: 1265716203
Provider Name (Legal Business Name): THOMPSON PSYCHOLOGY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4087 HIGHWAY 31 SW
FALKVILLE AL
35622-6319
US

IV. Provider business mailing address

4087 HIGHWAY 31 SW
FALKVILLE AL
35622-6319
US

V. Phone/Fax

Practice location:
  • Phone: 256-784-5433
  • Fax: 256-784-5852
Mailing address:
  • Phone: 256-784-5433
  • Fax: 256-784-5852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1701
License Number StateAL

VIII. Authorized Official

Name: DR. JUAN MICHAEL THOMPSON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 256-784-5433