Healthcare Provider Details

I. General information

NPI: 1619949484
Provider Name (Legal Business Name): BONNIE THOMPSON M.A.,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 MAIN ST SUITE 101
DELTA CO
81416-1864
US

IV. Provider business mailing address

540 MAIN ST SUITE 101
DELTA CO
81416-1864
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-8744
  • Fax: 970-874-8744
Mailing address:
  • Phone: 970-874-8744
  • Fax: 970-874-8744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number286
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: