Healthcare Provider Details

I. General information

NPI: 1992828131
Provider Name (Legal Business Name): RALPH COLBURN THOMPSON JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 3RD ST
ELYRIA OH
44035-5618
US

IV. Provider business mailing address

341 UNIVERSITY AVE 312 THIRD STREET
ELYRIA OH
44035-7153
US

V. Phone/Fax

Practice location:
  • Phone: 440-323-5707
  • Fax: 440-323-3016
Mailing address:
  • Phone: 440-323-5009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-989
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: