Healthcare Provider Details

I. General information

NPI: 1093313272
Provider Name (Legal Business Name): SCARLETT AMBER-LYNN THOMPSON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2020
Last Update Date: 10/11/2020
Certification Date: 10/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 HINKLE ST
CLOVIS NM
88101-5846
US

IV. Provider business mailing address

913 HINKLE ST
CLOVIS NM
88101-5846
US

V. Phone/Fax

Practice location:
  • Phone: 575-693-6609
  • Fax:
Mailing address:
  • Phone: 575-693-6609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberT-CTL0212751
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: