Healthcare Provider Details

I. General information

NPI: 1700168358
Provider Name (Legal Business Name): JUAN MICHAEL THOMPSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/09/2011
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: 256-466-1546
  • Fax:
Mailing address:
  • Phone: 256-466-1546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: