Healthcare Provider Details

I. General information

NPI: 1184717480
Provider Name (Legal Business Name): DONALD KEITH THOMPSON LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15267 MINCING LN.
CHANNELVIEW TX
77530
US

IV. Provider business mailing address

15267 MINCING LN.
CHANNELVIEW TX
77530
US

V. Phone/Fax

Practice location:
  • Phone: 281-452-2030
  • Fax:
Mailing address:
  • Phone: 281-452-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2823
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: