Healthcare Provider Details

I. General information

NPI: 1891525374
Provider Name (Legal Business Name): GABRIEL THOMPSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 MAPLE STREET
GREENVILLE MO
63944
US

IV. Provider business mailing address

290 MAPLE STREET
GREENVILLE MO
63944
US

V. Phone/Fax

Practice location:
  • Phone: 573-868-8010
  • Fax:
Mailing address:
  • Phone: 573-868-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026019651
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: