Healthcare Provider Details

I. General information

NPI: 1063158335
Provider Name (Legal Business Name): CHRISTINE CAROL THOMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 S NORTON AVE
SIOUX FALLS SD
57105-3730
US

IV. Provider business mailing address

2109 S NORTON AVE
SIOUX FALLS SD
57105-3730
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-2696
  • Fax: 605-339-9944
Mailing address:
  • Phone: 605-334-2696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number11515
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: