Healthcare Provider Details

I. General information

NPI: 1831543321
Provider Name (Legal Business Name): LORALYNNE THOMPSON BHP, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 S POWER RD STE 116
GILBERT AZ
85297-9282
US

IV. Provider business mailing address

22424 S ELLSWORTH LOOP RD UNIT 9
QUEEN CREEK AZ
85142-7027
US

V. Phone/Fax

Practice location:
  • Phone: 480-988-5003
  • Fax: 480-988-9799
Mailing address:
  • Phone: 480-331-1567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-15752
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-17864
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: