Healthcare Provider Details

I. General information

NPI: 1487905717
Provider Name (Legal Business Name): AMY MARIE ALLISON THOMPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CENTRAL AVE SUITE 305
GREAT FALLS MT
59401-3179
US

IV. Provider business mailing address

600 CENTRAL AVE SUITE 305
GREAT FALLS MT
59401-3179
US

V. Phone/Fax

Practice location:
  • Phone: 406-531-4557
  • Fax:
Mailing address:
  • Phone: 406-531-4557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4636
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWP-LCSW-LIC-4636
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: