Healthcare Provider Details

I. General information

NPI: 1164205191
Provider Name (Legal Business Name): CAITLIN M THOMPSON COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 LESLIE STREET
LANSING MI
48912
US

IV. Provider business mailing address

424 LESLIE ST
LANSING MI
48912-2623
US

V. Phone/Fax

Practice location:
  • Phone: 517-483-2461
  • Fax:
Mailing address:
  • Phone: 517-483-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CATHY GALLEGOS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 517-483-2461