Healthcare Provider Details

I. General information

NPI: 1710299250
Provider Name (Legal Business Name): JESSE DAVID THOMPSON LMFT, SAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10316 GREENBRIAR PL STE 1
OKLAHOMA CITY OK
73159-7649
US

IV. Provider business mailing address

10316 GREENBRIAR PL STE 1
OKLAHOMA CITY OK
73159-7649
US

V. Phone/Fax

Practice location:
  • Phone: 405-313-8452
  • Fax: 844-272-6181
Mailing address:
  • Phone: 405-313-8452
  • Fax: 844-272-6181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberMCB532
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: