Healthcare Provider Details

I. General information

NPI: 1003555426
Provider Name (Legal Business Name): MRS. ALEXANDRA LOUISE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA LOUISE KING

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 JEFFERSON BLVD
WEST SACRAMENTO CA
95605-2350
US

IV. Provider business mailing address

500 JEFFERSON BLVD
WEST SACRAMENTO CA
95605-2350
US

V. Phone/Fax

Practice location:
  • Phone: 312-533-6349
  • Fax:
Mailing address:
  • Phone: 312-533-6349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number137606
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number137606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: