Healthcare Provider Details

I. General information

NPI: 1184882763
Provider Name (Legal Business Name): ROBERT THOMSON MA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 TULANE DR SE
ALBUQUERQUE NM
87106-1413
US

IV. Provider business mailing address

705 CAMINO DEL BOSQUE NW
ALBUQUERQUE NM
87114-2307
US

V. Phone/Fax

Practice location:
  • Phone: 505-280-4351
  • Fax:
Mailing address:
  • Phone: 505-898-6476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0484
License Number StateNM

VIII. Authorized Official

Name: MR. ROBERT D THOMSON
Title or Position: PSYCHOTHERAPIST
Credential: M.A., LPCC
Phone: 505-280-4351