Healthcare Provider Details

I. General information

NPI: 1609948017
Provider Name (Legal Business Name): JOHN C THOMPSON LPC-MHSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 WEST BLYTHE ST SUITE 2
PARIS TN
38242-3423
US

IV. Provider business mailing address

204 WEST BLYTHE ST SUITE 2
PARIS TN
38242-3423
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-9026
  • Fax: 731-642-1838
Mailing address:
  • Phone: 731-642-9026
  • Fax: 731-642-1838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC717
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC0000000717
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC0000000717
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: