Healthcare Provider Details

I. General information

NPI: 1134656044
Provider Name (Legal Business Name): JAMES MONTGOMERY THOMPSON CDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 THOMPSON DR
SEDRO WOOLLEY WA
98284-5007
US

IV. Provider business mailing address

2106 OLD LAKEWAY DR
BELLINGHAM WA
98229-5315
US

V. Phone/Fax

Practice location:
  • Phone: 360-856-3481
  • Fax: 360-856-3138
Mailing address:
  • Phone: 360-224-8576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00000500
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: