Healthcare Provider Details

I. General information

NPI: 1740965854
Provider Name (Legal Business Name): JOSEPH CHRISTIAN THOMPSON LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E COLBY ST
WHITEHALL MI
49461-1113
US

IV. Provider business mailing address

2477 WINCHESTER DR APT 209
MUSKEGON MI
49441-3260
US

V. Phone/Fax

Practice location:
  • Phone: 231-893-8336
  • Fax:
Mailing address:
  • Phone: 231-327-3720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023036
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: