Healthcare Provider Details

I. General information

NPI: 1174774178
Provider Name (Legal Business Name): LAURIE E. THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CROWN POINT CIR. STE 100
GRASS VALLEY CA
95713
US

IV. Provider business mailing address

PO BOX 356
COLFAX CA
95713-0356
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-5440
  • Fax: 530-273-5440
Mailing address:
  • Phone: 530-615-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: