Healthcare Provider Details

I. General information

NPI: 1780350769
Provider Name (Legal Business Name): HEATHER THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 N GREEN VALLEY PKWY STE 100
HENDERSON NV
89074-1606
US

IV. Provider business mailing address

1915 N GREEN VALLEY PKWY STE 100
HENDERSON NV
89074-1606
US

V. Phone/Fax

Practice location:
  • Phone: 702-816-7836
  • Fax: 702-472-8877
Mailing address:
  • Phone: 702-816-7836
  • Fax: 702-472-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY1218
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: