Healthcare Provider Details

I. General information

NPI: 1275473449
Provider Name (Legal Business Name): KYRA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 E 5TH ST
TUCSON AZ
85711-2005
US

IV. Provider business mailing address

7065 E STRIKE EAGLE WAY
TUCSON AZ
85730-1052
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-0300
  • Fax:
Mailing address:
  • Phone: 520-369-7118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number24717
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: