Healthcare Provider Details

I. General information

NPI: 1194025197
Provider Name (Legal Business Name): AIMEE NICOLE THOMPSON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 17TH ST NW
ALBUQUERQUE NM
87104-1307
US

IV. Provider business mailing address

10701 RANCHITOS RD NE
ALBUQUERQUE NM
87122-2516
US

V. Phone/Fax

Practice location:
  • Phone: 505-270-0844
  • Fax:
Mailing address:
  • Phone: 505-270-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0131471
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: