Healthcare Provider Details

I. General information

NPI: 1336428168
Provider Name (Legal Business Name): PATRICIA THOMPSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LONGMONT ST
GILLETTE WY
82716-2927
US

IV. Provider business mailing address

700 LONGMONT ST
GILLETTE WY
82716-2927
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-0669
  • Fax: 307-686-2121
Mailing address:
  • Phone: 307-686-0669
  • Fax: 307-686-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-710
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: