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General NPI Number Information
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NPI Number | 1033848924
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Entity Type | Individual
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Provider Name | JESSICA HARLEY THOMPSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 3354 N PAULINA ST STE 205
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City | CHICAGO
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State | IL
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Zip | 60657-1087
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Country | US
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Telephone | 773-273-9719
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Fax |
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Provider Business Mailing Address
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Address Line | 5809 W WAVELAND AVE
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City | CHICAGO
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State | IL
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Zip | 60634-2664
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Country | US
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Telephone | 954-798-6871
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180016759
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License Number State | IL
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