Healthcare Provider Details

I. General information

NPI: 1992980965
Provider Name (Legal Business Name): MARK K THOMPSON LMHC, CAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 JOG RD STE #201
DELRAY BEACH FL
33446-1247
US

IV. Provider business mailing address

4880 N CITATION DR #104
DELRAY BEACH FL
33445-6552
US

V. Phone/Fax

Practice location:
  • Phone: 561-450-8328
  • Fax:
Mailing address:
  • Phone: 561-699-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 8939
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: