Healthcare Provider Details

I. General information

NPI: 1922794718
Provider Name (Legal Business Name): MARY THOMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20008 CHAMPION FOREST DR STE 601
SPRING TX
77379-8696
US

IV. Provider business mailing address

20008 CHAMPION FOREST DR STE 601
SPRING TX
77379-8696
US

V. Phone/Fax

Practice location:
  • Phone: 281-892-9986
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number86703
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: