Healthcare Provider Details

I. General information

NPI: 1831801042
Provider Name (Legal Business Name): ANDREW LEE THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 S 212TH ST
KENT WA
98031-1921
US

IV. Provider business mailing address

22926 126TH PL SE
KENT WA
98031-3664
US

V. Phone/Fax

Practice location:
  • Phone: 425-658-3016
  • Fax:
Mailing address:
  • Phone: 253-876-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA.BA.70136531
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: