Healthcare Provider Details

I. General information

NPI: 1013142306
Provider Name (Legal Business Name): JULIE ANN THOMPSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ELK ST
RAPID CITY SD
57701-7351
US

IV. Provider business mailing address

350 ELK ST
RAPID CITY SD
57701-7351
US

V. Phone/Fax

Practice location:
  • Phone: 605-343-7262
  • Fax:
Mailing address:
  • Phone: 605-343-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number58342-2
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: